Editor-in-Chief, Deputy Editor 2017-2019

 

Editor-in-Chief:

Tom MOREELS

 

Deputy Editor:

Nicolas LANTHIER

 

Letters



Endoscopic resolution of acute cholecystitis secondary to biliary fully covered metal stent


Price: €10,00

A 67-year-old man, with history of alcoholic chronic pancreatitis (CP), presented in the emergency department with intense pain in the right hypochondrium, and fever. Six months before, he underwent an endoscopic retrograde cholangiopancreatography (ERCP) with placement of a single plastic stent (8.5 Fr), for treatment of a common bile duct (CBD) stricture secondary to the CP. Four days before presentation, another ERCP was performed and the plastic stent was removed, and replaced for a fully covered self-expandable metal stents (FC-SEMS) [Evolution® Biliary, nitinol made, 60x10 mm (Cook Medical, Bloomington, Indiana, USA)], due to persistence of the CBD stricture, and the inability to place multiple plastic stents. [Product Details...]



Gastrointestinal tract and Russell bodies – a case report of Russell body carditis and review of the literature


Price: €10,00

We report a case of rare Russell body (RB) carditis and present an analysis of the available literature on this topic. Our patient was a 77-year-old man referred for gastroscopy because of non-cardiac chest pain and mild dysphagia. Endoscopy revealed several areas of different and mildly prominent mucosa in the gastroesofageal junction (Fig. 1). Biopsy samples obtained from the gastroesofageal junction showed nondysplastic intestinal metaplasia with mild chronic inflammatory infiltrate of edematous lamina propria and abundant plasma cells containing intracytoplasmic eosinophilic globules highlighted by a periodic acid-Schiff (PAS) ; findings were identified by pathologist as RBs (Fig. 2). Patient’s symptoms were controlled by PPI and prokinetics. Follow-up endoscopy with biopsies of different parts of upper GI tract was performed – without RBs presence except of the previously identified RB carditis. Russell bodies are acidophillic, intracytoplasmatic particles formed by immunoglobulin conglomerates that can be found in cells of many inflammatory, autoimmune and malignant diseases ; most commonly in hematooncological diseases (1). [Product Details...]



Ileal metastasis of a Colorectal Carcinoma in an asymptomatic patient confirmed by Single-Balloon Enteroscopy


Price: €10,00

Malignant neoplasms of the small bowel are unusual and often constitute a diagnostic and therapeutic challenge. Metastatic small bowel lesions, which are extremely uncommon, usually arise from lung, breast or gastric cancer; metastases originating from a primary colon cancer are particularly rare (1). Involvement of the small bowel usually occurs due to local invasion or peritoneal dissemination, rarely emerging from a direct hematogenous route (1). Small intestine metastases are usually revealed through bowel obstruction or bleeding, being rarely asymptomatic; hence, diagnosis almost always occurs during surgical procedures in an emergency setting (2). In asymptomatic patients, whose lesions are identified preoperatively, the diagnosis can be particularly defiant. We present the case of a female patient with a past history of colorectal carcinoma who developed a small bowel metastasis while asymptomatic. Balloon-assisted enteroscopy had a crucial role since it allowed prompt recognition and characterization of the lesion, thus enabling a proper therapeutic strategy which included preoperative chemotherapy. [Product Details...]



Imaging and histopathologic findings of desmoplastic small round cell tumor


Price: €10,00

Abdominal desmoplastic small round cell tumor (DSRCT) is an extremely rare malignancy (1). It typically affects young men with an aggressive clinical course (2). A 23-year-old male presented with constipation and poorly localized dull abdominal pain lasting for one month. He also suffered from poor appetite and unintentional weight loss. Abdominal examination revealed a palpable lower abdominal mass. [Product Details...]



Olmesartan-associated enteropathy. A rare but easily treatable entity


Price: €10,00

A 76-year old woman, with a history of atrial fibrillation, hypertension and hypothyroidism, was referred to our clinic due to a 6-month history of severe diarrhea (7-8 watery stools per day and weight loss of about 30kg). She also complained of intense pruritus in the past 3 months. She reported an unsuccessful trial of empirical treatment for scabies and inadequate response to oral antihistamines. At presentation, a widespread maculopapular rash with scabs was noted. Previous evaluation included a colonoscopy and esophagogastroduodenoscopy (without biopsies), an abdominal CT and MRI and an endoscopic ultrasound without significant findings. Laboratory tests at presentation revealed leukocytopenia, normocytic normochromic anemia, low serum protein and albumin, hypokalemia, and low Vitamin D. The rest of the lab tests were normal. Further workup during her hospital stay included : negative stool investigations (culture, parasitology and C. difficile toxin), negative HIV serology, normal blood smear examination and peripheral blood immunophenotyping, normal serum and urine protein electrophoresis and immunofixation, antinuclear antibodies titer 1:160, anti-smooth muscle antibodies titer 1:80, negative antimitochondrial antibodies, negative anti-parietal cell antibodies, normal IgG, IgA and IgM levels and negative celiac serology (anti-endomysial antibodies, and antitissue transglutaminase IgG and IgA). [Product Details...]



Pulmonary actinomycosis coexisting with intestinal tuberculosis as a complication of adalimumab treatment for Crohn’s disease


Price: €10,00

Tumor necrosis factor alpha (TNF-α) blocking agents are highly effective in inducing and mantaining remission in Crohn’s disease (CD) (1). However, due to the profound supression of T-cell mediated immunity, opportunistic infections still remain a major concern in this group of patients (2). We would like to draw attention to the unique case of a young patient with a imunomodulator therapy-resistant Crohn’s disease treated with adalimumab who developed pulmonary actinomycosis and intestinal tuberculosis despite adequate screening for latent tuberculosis. A 23-year old male patient, initially diagnosed with ileal CD at the age of 17 and maintained on azathioprine therapy with good outcome, was admitted with a severe flare of CD. After exclusion of tuberculosis on the basis of chest X-ray, negative PPD test and Quantiferon assay, induction therapy with adalimumab was initialised. After third dose of adalimumab he was hospitalized due to dry cough and diarrhea. X-ray and CT scan of the chest revealed an inflammatory infiltrate in the apical segment of the left lower lobe of the lung without signs of tissue destruction (Fig. 1). The bronchoscopy was performed and cytological evaluation of specimen was positive for Actinomyces meyeri and negative for mycobacteria. [Product Details...]


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