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Case Report

Acute abdomen due to intestinal angioedema induced by ACE inhibitors : not so rare?

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During the last 5 years we identified 7 patients with a history of episodic acute abdominal pain and subobstruction due to intestinal angioedema secondary to the use of Angiotensin Converting Enzyme (ACE) inhibitors. These cases were all diagnosed in one gastroenterology department. This is thereby the largest single centre case series of ACE inhibitor-induced angioedema that has been published until now. Our findings suggest that this syndrome is far more frequent than international literature would let us believe. We also describe one of the first male cases diagnosed with this entity for which there is a significant female predominance. In the presence of an appropriate history and suggestive findings on CT scan, this diagnosis can relatively easily be made if one is sufficiently intent on it. An appropriate diagnosis can save these patients a lot of unnecessary diagnostic procedures and discomfort. (Acta gastro enterol. belg., 2009, 72, 455-457). [Product Details...]

Anal transitional zone adenocarcinoma following restorative proctocolectomy for ulcerative colitis : case report and review of literature

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Conservative proctocolectomy with ileal pouch-anal anastomosis (IPAA) has become the intervention of choice for severe ulcerative colitis (UC) requiring surgery. Sporadically, the occurrence of carcinoma arising in or near the ileo-anal pouch after IPAA for UC has been reported. This issue is of utmost importance as an endoscopic follow-up is mandatory also after the operation. The present paper reports a case of cancer which developed four years after proctocolectomy with IPAA in a young man suffering from UC. Moreover, the authors provide update (PubMed research) by literature review on this issue. (Acta gastro enterol. belg., 2009, 72, 441-443). [Product Details...]

Diagnosis and surgical management of abdominal cocoon : results from 12 cases

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This study was designed to describe the characteristics, diag - nostic and therapeutic methods of abdominal cocoon. Twelve patients with abdominal cocoon were surgically treated. The clinical findings from these patients were analyzed. All patients presented with acute complete intestinal obstruction, and 10 had a previous history of abdominal mass. In nine patients, the whole or part of the small intestines were covered by an ash gray, dense and tough fibrous membrane. The capsule was surgically excised, and the adhesion was released. Partial resection of the small intestines was performed. In the other three patients, the small intestines were only partially covered by a membrane, and there was an extensive adhesion of intestinal tract, forming a large mass which could not be relieved by surgical lysis. Intestinal tube was put in, and fistulation procedures were performed. All patients recovered fully after the surgery. Conclusions : There are four types of surgical findings in abdominal cocoon. The most common type is that the small intestines are fully covered by a thick white membrane, causing intestinal obstruction. Surgical excision of the membrane and the release of adhesion is the treatment of choice. (Acta gastro enterol. belg., 2009, 72, 447-449). [Product Details...]

Giant small intestine gastrointestinal stromal tumor with gastrointestinal bleeding

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Small intestine stromal tumors are relatively rare and cause subtle clinical signs and symptoms. Their diagnosis is often delayed until complications develop. Even if complications occur, an exact preoperative diagnosis may be very difficult. Surgery remains the mainstay of treatment, and other treatment modalities are limited. We present herein a patient with a giant gastrointestinal tumor who presented with gastrointestinal bleeding. Complete resection was performed despite the large tumor size (23 20 8 cm) and the patient was free of signs and symptoms during the 4-month follow-up. (Acta gastro enterol. belg., 2009, 72, 458-461). [Product Details...]

Lemierre’s syndrome secondary to Fusobacterium necrophorum infection, a rare cause of hepatic abscess

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An 18 year old male was admitted to the Accident & Emergency department with complaints of abdominal pain, vomiting and diarrhoea. He was clinically jaundiced and further CT scan suggested liver abscess. Later on blood cultures showed gram-negative bacilli and a further liver aspirate culture confirmed the presence of the rare Fusobacterium necrophorum. A diagnosis of hepatic abscess secondary to Lemierre’s syndrome was made and patient was treated with appropriate antibiotics. Lemierre’s syndrome, although a rare condition, may be associated with serious lifethreatening complications. Early recognition and treatment is essential in successfully treating this rare condition. A review of Lemierre’s syndrome is presented. We recommend clinicians to be aware of this condition (Lemierre’s Syndrome) especially when dealing with young patients with sore throat and jaundice. It is important for primary care physicians to be aware of this condition as they are discouraged from prescribing antibiotics for young patients with sore throat. Although it is a rare condition, it is associated with severe life threatening complication like liver abscesses. (Acta gastro - enterol. belg., 2009, 72, 444-446). [Product Details...]

Tubulovillous adenoma in the common bile duct causing obstructive jaundice

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Villous adenomas are benign epithelial lesions with a malignant potential which can occur at any site in the gastrointestinal tract, usually in the rectum and colon, less frequently in the small bowel and very rarely in the biliary tract (1,2,3). Villous adenomas of the extrahepatic bile ducts are exceptional and only a few cases have been reported (4). Common bile duct (CBD) adenomas often present in a fashion similar to their malignant counterparts (5), and adenocarcinoma arising from a villous adenoma of the ampullary biliary epithelium is also extremely rare (6). We present here a tubulovillous adenoma, arising in the common bile duct, as a cause of obstructive jaundice, and discuss the characteristics of these lesions. (Acta gastro enterol. belg., 2009, 72, 450-454). [Product Details...]

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