Volume 82 - 2019 - Fasc.3 - Letters
Giant peritoneal loose body : a case report and review of the literature
We present a case about a 53-year-old man who complained of abdominal pain and constipation. Computed tomography showed a well-described nodular structure of 6cm in size with a central dense core of 0.5cm with compression against the rectosigmoid. The presence of a foreign body was suggested and a diagnostic laparoscopy was performed. Surgery revealed a giant peritoneal loose body measuring 5.5cm in diameter. After the removal, the patient was relieved of his symptoms.
Peritoneal loose bodies are usually small and asymptomatic. They are mostly found incidentally during laparotomy. Giant peritoneal loose bodies are a rare entity and diagnosis is difficult. A review of the literature is presented. (Acta gastroenterol. belg., 2019, 82, 441-443).
Two cases of peripancreatic cystic lymphangiomas diagnosed by EUS-guided FNA
Case 1 : A 51-year old male was referred for evalua- tion of a large cystic mass inferior to the uncinate process of the pancreas and anterior to the 3rd portion of the duodenum. He was asymptomatic. No abdominal tenderness or mass was appreciated. MRCP and MRI of the pancreas showed a T2 hyperintense, microlobulated, multiseptated, and multi-cystic mass measuring 6.0 x 5.1 x 3.6 cm overall. Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) of the cyst yielded 18 mL of milky-white fluid (Figure 1). Analysis of the cyst fluid revealed a CEA of 27.3 ng/mL, amylase of 47 U/L, and triglycerides of 6162 mg/dL. Cytology showed no malignant cells. A repeat MRI was obtained at a 1 year interval and showed no change in the lesion.
Cryptosporidiosis in a patient with Crohn's disease under anti-TNF treatment
Ulcerative Colitis (UC) and Crohn's Disease CD), are chronic inflammatory bowel diseases (IBD) which may benefit from the treatment with biologic agents which target specific cytokines involved in inflammation (1). The anti-TNF therapy is the first biologic agent used in the treatment of complicated CD (2). Although the clinical efficacy of anti-TNF agents has been proven, their use may also be associated with an increased risk of opportunistic infections caused by bacteria, viruses and parasites (3). Cryptosporidiosis is a parasitic infection caused by Cryptosporidium Spp, clinically characterized by watery diarrhea, often profuse and prolonged, abdominal pain, nausea, vomiting, and fever. Cryptosporidium is an emerging protozoan parasite and it can be transmitted to humans from animals, from humans and from contaminated food or water. Disease severity varies according to the host general health: immunocompetent patients may develop a mild, self- limiting disease, while immunocompromised patients, may have severe and persistent symptoms, with gastrointestinal, biliary or respiratory manifestations (4).
Whether the use of biologic agents is associated to an increased risk of infection by Cryptosporidium Spp is not clear.
