Editor-in-Chief, Deputy Editor 2017-2019

 

Editor-in-Chief:

Tom MOREELS

 

Deputy Editor:

Nicolas LANTHIER

 

Case Reports



Acute cholecystitis caused by hemocholecyst : Unusual clinical manifestation of gallbladder cancer


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Gallbladder cancer presenting as acute cholecystitis associated with a hemocholecyst is a rare entity. Up to date there are only 2 cases reported in literature. Acute cholecystitis may appear secondary to an obstruction of the cystic duct by the tumour itself or to an obstruction of the cystic duct by blood clots. Case report : A 74-years-old woman complained of right upper quadrant pain during the last 48 hours, associated to fever of 38ºC and vomits. Physical examination revealed a positive Murphy’s sign. Laboratory data showed leukocytosis and mild increasement of liver enzymes. Ultrasonography revealed a mobile extense formation located antigravitatorily in fundus and body of the gallbladder. CT scan showed a mass adhered to the fundus and the body of the gallbladder without wall infiltration and contrast enhancement, suggestive of hemocholecyst. Laparoscopic cholecystectomy was performed, observing cholecystitis signs without any other relevant features. Pathology revealed a large amount of clotted blood inside the gallbladder, some of them obstructing the cystic duct ; an irregularity was discovered in the gallbladder wall, whose microscopic analysis revealed a gallbladder adenocarcinoma, infiltrating up to the serosa (T3NxMx). The patient underwent a second operation with resection of the gallbladder bed and lymph node dissection of the hepatic hilium, without evidence of neoplastic infiltration. (Acta gastroenterol. belg., 2013, 76, 57-58). [Product Details...]



Colonic tuberculosis or Crohn’s disease ? An important differential diagnosis


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Abdominal tuberculosis can mimic any disease affecting the gastrointestinal tract such as infectious processes, tumors, periappendiceal abscess, and Crohn’s disease. The differential diagnosis of Crohn’s disease and intestinal tuberculosis is a dilemma to clinicians and pathologists as both are chronic granulomatous disorders with similar clinical features. Lower gastrointestinal bleeding is an infrequent presentation of both intestinal tuberculosis and Crohn’s disease. Herein, we report a 56-year-old woman presenting with massive hematochezia due to isolated colon tuberculosis in whom the initial diagnostic work-up suggested Crohn’s disease and review the current literature. Our report highlights the need for awareness of colonic tuberculosis in the differential diagnosis of massive hematochezia from Crohn’s disease, especially before initiating treatment with immunosuppressive agents. (Acta gastroenterol. belg., 2013, 76, 59-61). [Product Details...]



Spontaneous liver bleeding in a patient with congenital arterioportal fistulisation. Presentation of a casus princeps and review of the literature


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We present the first case reported in the literature describing spontaneous liver haemorrhage due to diffuse arterioportal fistulae. A 48-year old Caucasian woman was admitted to the hospital complaining of acute epigastric pain eradiating to the right shoulder. Patient never had any penetrating or blunt abdominal trauma in the past nor any intervention on the liver. CT scan of the abdomen revealed a subcapsular haematoma originating from two bleeding sites in the right liver lobe. Arteriography of the common hepatic artery showed opacification of the portal branches, indicative of an arterioportal fistula. A hypertrophic feeding branch of the right hepatic artery was then embolized, resulting in disappearance of the fistula. After complete resolution of the haematoma, investigations to detect underlying liver lesions were repeatedly negative. Therefore we conclude that a diffuse congenital arterioportal fistula was the cause of spontaneous bleeding. This is to our knowledge the first case in whom a spontaneous liver bleeding secondary to diffuse arterioportal fistulisation is reported. A review of the literature regarding arterioportal fistulas and regarding the possible aetiology of spontaneous liver haematomas is provided. (Acta gastroenterol. belg., 2013, 76, 62-65). [Product Details...]


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