Volume 72 - 2009 - Fasc.3 - Case reports
Cerebral venous sinus thrombosis as presenting feature of ulcerative colitis
Thrombosis is a well recognized complication of inflammatory bowel disease that occurs in 1.3 to 6.4% of patients, however, cere- bral vascular involvement is unusual. We present the case of a 16- year-old female in whom cerebral venous thrombosis was the pre- senting symptom of an active ulcerative pancolitis. Thrombophilia screen (plasma levels of proteins C and S, antithrombin, antibeta2- glycoprotein, lupus anticoagulant and anticardiolipin antibodies, activated protein C resistance, homocystein level antinuclear anti- bodies) was negative. The patient was successfully treated with anticoagulant therapy, phenobarbital and sulfasalazine. Cerebral venous thrombosis is an exceptional presenting feature of ulcera- tive colitis. Disease activity may play a major role in the occurrence of thrombosis. (Acta gastroenterol. belg., 2009, 72, 350-353).
Emphysematous gastritis causing gastric and esophageal necrosis in a young boy
Emphysematous gastritis is a rapidly fatal and rare type of infectious gastritis. It may lead to involvement of esophagus, and organ necrosis, in its severe form. A 16-year-old, previously healthy, boy presenting with acute abdomen was diagnosed to have emphysematous gastritis on CT scan. During laparotomy, there was complete necrosis of the stomach, with patchy esophageal involvement. Aggressive management in the form of total gastrec- tomy, and later, transthoracic esophagectomy was done. However, it failed to alter the course of the illness, and the patient succumbed to the illness. Emphysematous gastritis is rare in young patients without known risk factors. AlsO. only two previous cases have been reported with esophageal involvement. We have presented this case with a brief review of literature. (Acta gastroenterol. belg., 2009, 72, 354-356).
Endoscopic closure of a large iatrogenic rectal perforation using endoloop-clips technique
Retroflexion to evaluate the rectal vault provides significant additional information compared with standard forward view of the rectum. The procedure is easily performed with rare complica- tions and is well tolerated by patients. We describe the first case of a large oval rectal perforation after retroflexion of the colonoscope in a healthy rectum during a follow-up colonoscopy, immediately closed with the endoloop/clips technique. The patient had an uneventful course and was discharged after 5 days. At his 2-month follow-up visit he remained asymptomatic and endoscopy revealed complete healing of the perforation. (Acta gastroenterol. belg., 2009, 72, 357-359).
Repair of an EUS - induced duodenal perforation with endoscopic clips
Endoscopic ultrasound (EUS) is considered a safe procedure ; however, rare deaths have been reported due to complications such as perforation of the gastrointestinal tract. Several factors includ- ing age, the presence or absence of cervical osteophytes or duode- nal diverticula, history of difficult intubation with prior endoscop- ic procedure, endosonographer's inexperience, or EUS guided interventions such as the drainage of the pancreatic duct or pseudocyst and fine needle aspiration may increase the risk of EUS related perforation of the gastrointestinal tract. We report a patient with pancreatic mass who developed duodenal perforation during EUS and was treated successfully with an immediate clo- sure of perforation using endoscopic clips combined with bowel rest and antibiotics. Based on our patient and others reported in the literature, immediate recognition and closure of perforation with endoscopic clips may be useful in the management of patients with EUS induced duodenal perforation. However, surgical consul- tation and close clinical monitoring is required in the management of these patients. (Acta gastroenterol. belg., 2009, 72, 361-364).
Abdominal pain and vomiting as first sign of mitochondrial disease
We describe a patient in whom abdominal pain and vomiting were the presenting symptoms of Mitochondrial Myopathy Encephalopathy, Lactic Acidosis with Stroke-like episodes syn- drome (MELAS). Mitochondrial disorders usually present with neurological symptoms or with myopathic features at any age. Although many patients develop visceral symptoms at a certain moment during the course of the disease, only in a minority of patients these symptoms are the unique presenting ones. The proband was initially diagnosed as having gastro-oesophageal reflux and it was only after detailed clinical history that an under- lying metabolic defect was suspected and the molecular defect identified. (Acta gastroenterol. belg., 2009, 72, 365-368).
Primary myeloid sarcoma of the jejunum and greater omentum causing small intestine obstruction
Myeloid sarcoma, which is highly associated with acute myeloid leukemia, is defined as an extramedullary discrete tumor mass, consisted by immature myeloid cells or myeloblasts. Myeloid sar- coma usually involves the skin, lymph node, bone, soft tissue and testis, while involvement of the gastrointestinal tract is rather uncommon. The diagnosis depends on histological features and immunohistochemical results. We present a rare case of myeloid sarcoma, with synchronous involvement of the jejunum and the greater omentum, manifesting with small bowel obstruction. (Acta gastroenterol. belg., 2009, 72, 369-372).
Esophageal squamous papillomatosis with dysplasia. Is there a role of balloon- based radiofrequency ablation therapy ?
Esophageal squamous papillomatosis (ESP) is a rare condition, occurring in an estimated 0.01-0.097% in data from upper gas- trointestinal endoscopies and autopsy series (1-2). Chronic mucos- al irritation and infection with human papilloma virus (HPV) are proposed etiologies (1). Heavy use of tobacco and alcohol are com- mon associations. The premalignant potential of ESP has long been debated in literature. The clinical course is variable, ranging from spontaneous regression to the development of squamous cell carci- noma (3-5). Due to the paucity of reported cases, no generalized therapeutic or surveillance recommendations exist. Photodynamic therapy (PDT) has been successfully used to treat Barrett's esoph- agus as well as superficial adenocarcinoma (6). However, its safety and efficacy in treating ESP with dysplasia is lacking. Balloon- based radiofrequency ablation using the HALO90 Ablation System is designed to remove the diseased cells using controlled heat. In recent clinical trials, it has shown great promise in treating Barrett's esophagus with high-grade dysplasia (7-9). We report the first ever use of balloon-based radiofrequency ablation to treat ESP with dysplasia. Clinical symptoms resolved after the first ther- apy session, however, ablation therapy was terminated early because squamous cell carcinoma in-situ was detected on surveil- lance endoscopy prior to the fourth therapy session. Although we failed to treat type 4 ESP with high-grade dysplasia with balloon- based radiofrequency ablation therapy, we believe that it might play a role in treating other localized types of ESP. (Acta gastro- enterol. belg., 2009, 72, 373-376).
