Editor-in-Chief, Deputy Editor 2017-2019

 

Editor-in-Chief:

Tom MOREELS

 

Deputy Editor:

Nicolas LANTHIER

 

Letters



A catastrophic event caused by pasteurella multocida in an alcoholic cirrhotic patient


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Pasteurella multocida is a gram negative cocco - bacillus that is a zoonotic agent of human disease. It is present in the nasopharynx of cats and dogs. It may cause serious soft tissue infections, less commonly it may cause sepsis or septic shock presenting with disseminated intravascular coagulation and acute renal failure. Invasive forms of pasteurella infection more frequently occur in immuncompromised patients (1,3). We report a case of rapidly proceeding lethal septicemia due to infection with P. multocida in a woman with alcoholic liver cirrhosis. [Product Details...]



An infrequent variant of Stauffer’s syndrome


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Cholestasis could be a paraneoplastic manifestation of underlying malignancies. Stauffer’s syndrome is a rare paraneoplastic manifestation of renal cell carcinoma characterized by abnormal liver enzymes and usually without hepatic metastasis and jaundice. Little is known about the cholestatic variant of Stauffer’s syndrome. Stauffer’s syndrome variant is reported as one of the unusual presentations. A 27 year old man was admitted to the hospital for generalized pruritis, yellowish discoloration of his eyes, and dark urine for 2 weeks. He also had nausea and few episodes of vomiting for 2 days. On exam patient was deeply icteric, had upper abdominal tenderness with guarding and left flank mass. Laboratory work up revealed microcytic anemia, elevated AST, ALT and alkaline phosphatase with a primarily conjugated hyperbiliurbinemia. Hepatitis profile showed negative hepatitis C Antibody, negative hepatitis A antibody and immunity to hepatitis B. Antinuclear antibody was negative and anti-smooth muscle antibody was elevated at 42.1 (Table 1). [Product Details...]



Both biliopleural fistula and portal hypertension with giant hydatid cyst of the liver


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Hydatid disease still remains an important health problem in endemic regions such as the Mediterranean. The most common complication of liver hydatid cyst is rupture in the biliary tree. Biliopleural fistula and portal hypertension are rare complications due to hydatid cyst. However, these two complications have not previously been reported in the same case. We present a case report in which a giant liver hydatid cyst was complicated with both biliopleural fistula and portal hypertension. [Product Details...]



ERCP in patients with jaboulay pyloroplasty


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Endoscopic retrograde cholangiopancreatography (ERCP) is successfuly performed in a substantial percent of patients with surgically altered gastrointestinal and/or bilio-pancreatic anatomy using an appropriate endoscope and other instruments (1,2). Billroth II gastroenterostomy, Roux-en-Y hepaticojejunostomy, Whipple procedure, gastrojejunal bypass are the most commonly performed examples (Table 1). Access to the papilla must be through an afferent loop using a duodenoscope, gastroscope, colonoscope, pediatric colonoscope or enteroscope (including balloon enteroscope) (1-7). Jaboulay pyloroplasty (JP) is a side-to-side antroduodenostomy anastomosis aimed to relieve gastric outlet obstruction that is infrequently performed currently (Fig. 1) (8). To our knowledge there is no data in the literature regarding the ERCP interventions in patients with JP. Herein we present our ERCP experience in patients with JP. [Product Details...]



Fatal fulminant hepatitis B after withdrawal of entecavir treatment in a patient with HBeAg seroconversion


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The presence of hepatitis B e antigen (HBeAg) is often associated with ongoing liver disease, whereas HBeAg seroconversion often coincides with loss of serum hepatitis B virus (HBV) DNA, normalization of liver biochemical tests, clinical remission and sub sidence of hepatic inflammatory activity (1). Herein we desribe a patient with HBeAg reversion with acute liver failure after discontinuation of entecavir therapy. [Product Details...]



Freehand endoscopic lithotripsy for Bouveret’s Syndrome


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An 81-year-old female patient was admitted to our hospital with a 6-day history of abdominal pain and multiple episodes of vomiting. Abdominal CT showed an extensive pneumobilia, a contracted gallbladder that communicated with the duodenum, and an ovoid, calcified mass in duodenal bulb. At the esophagogastroduodenoscopy, a large calculus was seen in the duodenal bulb (Fig. 1). Due to the patient’s advanced age and significant comorbidities, endoscopic treatment was advocated. The stone was captured with a polypectomy snare and pulled back through the pyloric channel into the stomach. The stone measured 3 cm in its longest dimension. Since attempts to remove the stone orally were unsuccessful, a lithotriptor (Trapezoid RX, Boston Scientific, USA) was inserted in a freehand manner. [Product Details...]



Gastrointestinal stromal tumor in the duodenal blind spot : role of pediatric colonoscope and endoscopic ultrasound


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We read the article titled “An unusual cause of upper gastrointestinal bleeding : duodenal GIST. A case report and literature review” published in June 2011 issue of Acta Gastro-Enterologica Belgica with much interest (1). Gastrointestinal stromal tumors (GIST) account for 0.1-3% of gastrointestinal tumors with an annual incidence of 10-15 per million people (2). Mostly presenting as gastrointestinal bleeding (GIB), over twothirds of GISTs are located in stomach and, therefore, easily detected with a gastroscope. As Mehta and colleagues have pointed out, GISTs located in the 3rd and 4th parts of duodenum are beyond the reach of gastroscope and require push enteroscopy for their detection. We describe a case of obscure GIB where a routine gastroscope twice failed to visualize a mucosal bulge located at the junction of 1st and 2nd parts of duodenum located otherwise well within the working length of gastroscope. A push enteroscopy performed with a pediatric colonoscope was able to visualize an abnormality, likely due to its wider field of view and angulation. [Product Details...]



Pancreatitis associated panniculitis


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Severe pancreatitis can provoke systemic inflammation and even lung injury and shock. Fat necrosis can be observed in peripancreatic, mesenterial and retroperitoneal fat and at distant foci. Panniculitis is defined as an inflammation of subcutaneous fat that underlies the epidermis of the skin. It may involve either the fat lobules themselves or the connective tissue septa between the lobules. Clinically, panniculitis presents as ill-defined, tender, edematous, erythematous and red brown or blue nodules. The differential diagnosis of the clinically nonspecific nodules is brought (erythema nodosum, abscess, erythema induratum, lupus profundus, Weber-Christian disease, or cutaneous metastases) but only one type of lobular and septal panniculitis without vasculitis is typically associated to severe pancreatic disease and then called pancreatic panniculitis (1). Clinically the subcutaneous lesions are painful in about 50% of the cases, requiring analgesics and often precede the clinical symptoms of pancreatitis (2). They present more typically on the lower limbs but they can also occur on any other part of the body : trunk, abdomen (Fig. 1), arms, thighs and buttocks (Fig. 2). [Product Details...]


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