Louisiana Research Day Program Book 2025

Case Studies: Section 1

Case Studies: Section 1

Madeline Washburn, DO 1 ; Anupama Ancha, MD 2 ; Justin Bejcek, MS 2 ; Alexis Bejcek, MD 2 ; Christopher Williams, MD 2 1 BSW Medical Center; Dept. of Medicine, Division of Internal Medicine, Temple, TX; 2 BSW Medical Center; Dept. of Medicine, Division of Gastroenterology, Temple, TX; 3 VCOM-Louisiana; Dept. of Medical Education, Monroe, LA 72 A BAND FORGOTTEN IN TIME, AN ATYPICAL PRESENTATION OF A GASTRIC MASS

Julia Corteguera, OMS-III; Najma Ibrahim, OMS-III; Gwen Jackson, MD; John Whit Gallaspy, MD VCOM-Louisiana; Christus Cabrini Health Department of OBGYN 73 BREAKING BILE: A NOVEL APPROACH TO MANAGING INTRAHEPATIC CHOLESTASIS OF PREGNANCY WITH LACTULOSE

Background: In 1980, Dr. Marcel Molina placed his first non-adjustable gastric band using Dacron, a polyester fiber. This innovation provided patients with a non-invasive, reversible means to aid in weight loss by placing the band at the gastroesophageal junction, forming a small pouch to increase satiety. Gastric bands have decreased in popularity due to complications, including bleeding, infection, obstruction, perforation, and gastroesophageal reflux. Less frequently, patients may develop later onset complications, including band slippage and erosion with band migration, which can lead to re-operative procedures, complete removal, band adjustments, or other invasive bariatric surgeries. This case presents a unique occurrence of a non-adjustable gastric band erosion presenting as an intraluminal mass within a hiatal hernia in an asymptomatic patient diagnosed on endoscopic assessment. A 63-year-old female with a history of obesity status-post gastric lap band surgery 30 years prior presented to the gastroenterology clinic for evaluation of an incidental finding on abdominal imaging. She was following up with urology for hematuria when a CT urogram found a moderate-sized hiatal hernia with an

intraluminal soft tissue mass and adjacent enlarged paraesophageal lymph nodes concerning neoplasm (Figure 1). The patient denied any symptoms of dysphagia, epigastric pain, or melena. She agreed to undergo esophagoduodenoscopy (EGD) to investigate the findings and rule out malignancy. During the procedure, the endoscopists discovered a mesh-like material eroding through the gastric wall, occupying a large part of the diaphragmatic hiatus (Figure 2). The foreign body material was consistent with the lap band, which was placed 30 years prior to this evaluation. After sharing decision-making with the patient, she was seen by the bariatric surgery clinic. Then, she proceeded with laparoscopic removal of the eroded band, partial gastrectomy with Roux-en-Y reconstruction, and repair of the paraesophageal hiatal hernia. The concept, design, and immediate outcomes demonstrated by the non-adjustable gastric bands were initially favorable. However, this procedure has significantly decreased in popularity due to a rise in complications. The inherent obstructive mechanism that led to its effectiveness was also noted to lead to serious long-term complications, as seen in our case. Although

asymptomatic, our patient’s inflammatory reaction to the Dacron band and the erosion that resulted were unfortunate complications that required intervention. Our case highlights the importance of using endoscopy for further assessment of abnormal imaging, including surgical complications in the differential diagnoses of intraluminal masses, and obtaining a thorough surgical history, including interventions completed decades before evaluation.

Abstract: Intrahepatic cholestasis of pregnancy (ICP) is a liver disorder unique to pregnancy, characterized by pruritus and elevated levels of bile acids and liver transaminases, typically manifesting in the second or third trimester. Although ICP usually resolves postpartum and rarely results in severe maternal complications, it carries significant risks for fetal outcomes, including preterm birth, stillbirth, and neonatal respiratory distress. The standard treatment involves ursodeoxycholic acid (UDCA), often accompanied by planned early delivery to mitigate fetal risks. This case report describes a novel therapeutic approach using lactulose to manage ICP in a 23-year-old G2P1001 woman who presented at 37 weeks of gestation with intense pruritus and elevated bile acid levels. Lactulose therapy was initiated, leading to a substantial reduction in bile acid levels. This improvement enabled the pregnancy to continue until 38 weeks, culminating in an uncomplicated delivery of a healthy infant. This case highlights the potential of lactulose as an alternative therapeutic approach for ICP, emphasizing the need for further research to validate its efficacy and safety.

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2025 Research Recognition Day