Editor-in-Chief, Deputy Editor 2017-2019

 

Editor-in-Chief:

Tom MOREELS

 

Deputy Editor:

Nicolas LANTHIER

 

Letters



Acute pancreatitis after severe opthalmic adenoviral infection


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Viral etiology of acute pancreatitis (AP) is well established but there have been only isolated case reports of AP following viral infections, most commonly coxsackie and mumps virus infections (1). The role of viral infections in the etiopathogenesis of pancreatitis has been examined in both animal and human studies (2), also Tanimura et al. defined necrotizing pancreatitis associated with adenovirus infection in chickens (3). Adenoviruses cause a variety of diseases such as pharyngoconjunctival fever, follicular conjunctivitis, epidemic keratoconjunctivitis, myocarditis, hemorrhagic cystitis and acute diarrhea and invagination (4). They are common opportunistic pathogens and are rarely associated with severe clinical symptoms in healthy individuals. In contrast, in patients with compromised immunity, they often result in disseminated and potentially life-threatening disease (5). Infection frequently involves the organ system transplanted but disseminated disease involving the brain, spleen, bladder, lymph nodes, pancreas, eyes, and cervix also has been reported. Disseminated disease occurs rarely in the immunocompetent patients ; however, fatal reports of adenoviral infections have been described in previously healthy children and military recruits (6). [Product Details...]



Advanced adenocarcinoma in a laterally spreading adenoma within a colonic diverticulum, followed-up for 4 years


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Colonic neoplasia can arise from normal mucosa near or within a diverticulum. However, an adenocarcinoma arising within a diverticulum is a very rare phenomenon and to date only sporadic cases have been reported (1-8). Due to the lack of muscular layers within the diverticulum, the use of endoscopic polypectomy of a tumour within the diverticulum carries a risk of colonic perforation. Additionally, it is usually difficult to determine whether the tumour component is benign or malignant ; hence, special precautions should be implemented in the diagnosis and treatment of such patients. A 71-year-old man was admitted to Nishijin Hospital because of melena on November 5, 2009. A laterally spreading tumour (LST) of adenoma developing in a right-sided colonic diverticulum was observed on colonoscopy, and pathological examination revealed moderate atypia from a biopsy obtained in April, 2005. There were no changes observed in the tumour four years later as determined by endoscopic examination on his latest admission. Surgical intervention was consequently recommended but refused by the patient. The patient underwent an emergent colonoscopy for his melena, which showed right-sided diverticular hemorrhage. Endoscopic hemostasis with clips was unsuccessfully attempted twice, after which an emergency right hemicolectomy was performed. Grossly, the diverticulum with clips was located in the middle of the ascending colon. [Product Details...]



Endobronchial metastases from colorectal cancer


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Pleural and parenchymal lung metastases are frequent in colorectal cancer but endobronchial involvement is rare. An endobronchial metastasis (EBM) is defined as a bronchoscopically visible lesion with the same histology as the primary tumor from which it derives, in patients with extrapulmonary malignancies associated with or without parenchymal or mediastinal lesions. Invasion of the tracheobronchial tree by parenchymal masses or lymph nodes are not considered EBM. Recently a 83-year old man presented with an endobronchial tumoral mass with occlusion of the right middle bronchus, retro-obstructive atelectasis and a right-sided pleural effusion (Fig. 1). On bronchoscopic examination, a complete tumoral obstruction of the right middle bronchial branch was seen. Immuno histo - chemical analysis of the endobronchial biopsies revealed a poorly differentiated cylindric adenocarcinoma, corresponding to the histology of a colorectal carcinoma resected seven years before (at that time staged as pT3N0M0). On CT-scan of the abdomen there were no metastatic lesions. [Product Details...]



Post-cholecystectomy amputation neuroma mimicking common bile duct carcinoma


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Amputation neuromas, also known as traumatic neuromas represent reactive proliferation of nerve fibers that are encased in Schwann cells (1). Amputation neuroma of the common bile duct can occur after cholecystectomy because the common bile duct is surrounded by an abundant nerve supply (2). They always occur at the distal ends of the proximal segments of severed nerves and are characterized by a neural enmeshment in an overgrowth of the Schwannian sheath cells (3). Amputation neuromas are usually found in amputated extremities but they have been reported following radical mastectomy, mastoidectomy, thyroglossal cystectomy and even circumcision (4). Amputation neuromas of the biliary tract are usually asymptomatic, rarely they present with intermittent symptomatic right upper quadrant pain and jaundice. In most cases, the leading differential diagnosis is cholangiocarcinoma due to the similarity of presentation (2,5). [Product Details...]



Toxic megacolon due to fulminant Clostridium Difficile colitis


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A 92 year-old male patient was submitted for an elective right nephrectomy for kidney adenocarcinoma. Postoperatively, a three-day hospitalization in the ICU was required during which ampicillin/sulbactam was prophylactically administrated. From the 7th to the 9th postoperative day, he developed extensive abdominal distention, diffuse abdominal pain, diminished bowel sounds, fever (> 38.9°C), elevated leukocytosis (WBC 46,200 cells/μL), signs and symptoms compatible with systemic toxicity (hypotension and tachycardia), but no diarrhea. Plain Abdominal X-ray disclosed a toxic megacolon (transverse colon diameter > 10 cm) and absence of air in the rectal lumen, without radiological signs of obstructive ileus or volvulus. Colonoscopy with minimal gas insufflation, showed an inflamed and edematous mucosa with numerous discrete raised nodular lesions covered with yellow exudates up to the splenic flexure in a dilated and non-peristaltic bowel (Fig. 1). Stool cultures were positive for clostridium difficile. [Product Details...]


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