Volume 69 - 2006 - Fasc.4 - Case reports
Leptomeningeal carcinomatosis associated with oesophageal adenocarcinoma : two case reports and review of the literature
Leptomeningeal carcinomatosis (LC) is a rare complication of solid tumours. We report two cases of leptomeningeal carcino- matosis in patients with oesophageal adenocarcinoma. Diagnosis of LC can be overlooked without a high index of suspicion. Multifocality of symptoms and signs is the hallmark of LC. The combination of cerebrospinal fluid cytology and magnetic reso- nance imaging has a high diagnostic accuracy. The prognosis remains poor and therefore all therapies are still palliative. (Acta gastroenterol. belg., 2006, 69, 377-380).
Transient recurrent ascites
Angiotensin-converting enzyme (ACE) inhibitors are widely used in heart diseases.
We describe a case of a young woman treated with fosinopril. She started experiencing abdominal pain, vomiting and diarrhoea with peritoneal signs on physical examination three years after her treatment has been initiated. She presented ascites and signs of ileitis on imaging studies. She even underwent surgery. The diag- nosis of ACE inhibitor-induced angiooedema of the small bowel was made after the fourth episode. Fosinopril was stopped and the symptoms never recurred. The case we describe illustrates clinical presentation, radiological findings and difficulty of making an accurate diagnosis in such a patient. (Acta gastroenterol. belg., 2006, 69, 381-383).
Protein-losing Enteropathy in Crohn's Disease
Protein-losing enteropathy (PLE) is a rare but severe complica- tion of Crohn's disease (CD) and hypoalbuminemia can be one of the presenting symptoms of this illness. The diagnosis of PLE can only be made after exclusion of malnutrition and liver or kidney failure. Significant intestinal leakage can be caused by mucosal injury, increased lymphatic pressure or dilated lymphatics and has been reported in a large number of diseases. The protein- losing can be diagnosed by assessing the excretion of different radiolabeled macromolecules in the faeces or by the clearance of alpha-1-antitrypsine in stools. The primary approach should be the optimization of the nutritional status. Medical treatment of the underlying disease is primordial. In other cases surgical resection of the most affected areas is inevitable.
We report a case of a 21-year-old male with a 4 year history of CD, who developed significant hypoproteinemia with pitting oede- ma, initially in the absence of any other sign of severe disease activity. A 51Cr-chloride albumin excretion confirmed our hypo- thesis of protein-losing enteropathy. Because of sub-obstruction signs some months later, a laparotomy was performed which revealed a severely affected loop with dilatation of the proximal jejunum. Interestingly, multiple large lymph nodes and dilated lymphatics were seen. A partial jejunal resection was performed for stricturing Crohn's disease. Histology showed severe mesen- teric granulomatosis, dilated lymph vessels and granulomatous vasculitis. After the resection our patient improved without further albumin infusions and the oedema resolved. (Acta gastro- enterol. belg., 2006, 69, 384-389).
Pericarditis in exacerbation of ulcerative colitis
Acute pericarditis occurs very rarely in association with inflam- matory bowel disease (IBD). It has been described both as an extraintestinal manifestation of IBD and as an adverse drug reac- tion in IBD treatment. We present a case of a 26-year-old female patient with a severe exacerbation of ulcerative colitis, who was previously under long-term treatment with mesalazine and low- dose prednisone. The literature on pericardial involvement in IBD is reviewed. (Acta gastroenterol. belg., 2006, 69, 390-392).
Transient recurrent ascites
Angiotensin-converting enzyme (ACE) inhibitors are widely used in heart diseases.
We describe a case of a young woman treated with fosinopril. She started experiencing abdominal pain, vomiting and diarrhoea with peritoneal signs on physical examination three years after her treatment has been initiated. She presented ascites and signs of ileitis on imaging studies. She even underwent surgery. The diag- nosis of ACE inhibitor-induced angiooedema of the small bowel was made after the fourth episode. Fosinopril was stopped and the symptoms never recurred. The case we describe illustrates clinical presentation, radiological findings and difficulty of making an accurate diagnosis in such a patient. (Acta gastroenterol. belg., 2006, 69, 381-383).
