Volume 75 - 2012 - Fasc.3 - Letters
A catastrophic event caused by pasteurella multocida in an alcoholic cirrhotic patient
Pasteurella multocida is a gram negative cocco- bacillus that is a zoonotic agent of human disease. It is present in the nasopharynx of cats and dogs. It may cause serious soft tissue infections, less commonly it may cause sepsis or septic shock presenting with disseminat- ed intravascular coagulation and acute renal failure. Invasive forms of pasteurella infection more frequently occur in immuncompromised patients (1,3). We report a case of rapidly proceeding lethal septicemia due to infection with P. multocida in a woman with alcoholic liver cirrhosis.
Both biliopleural fistula and portal hypertension with giant hydatid cyst of the liver
Fatal fulminant hepatitis B after withdrawal of entecavir treatment in a patient with HBeAg seroconversion
The presence of hepatitis B e antigen (HBeAg) is often associated with ongoing liver disease, whereas HBeAg seroconversion often coincides with loss of serum hepatitis B virus (HBV) DNA, normalization of liver biochemical tests, clinical remission and sub sidence of hepatic inflammatory activity (1). Herein we desribe a patient with HBeAg reversion with acute liver failure after discontinuation of entecavir therapy.
Pancreatitis associated panniculitis
Severe pancreatitis can provoke systemic inflamma- tion and even lung injury and shock. Fat necrosis can be observed in peripancreatic, mesenterial and retroperi- toneal fat and at distant foci. Panniculitis is defined as an inflammation of subcutaneous fat that underlies the epi- dermis of the skin. It may involve either the fat lobules themselves or the connective tissue septa between the lobules. Clinically, panniculitis presents as ill-defined, tender, edematous, erythematous and red brown or blue nodules. The differential diagnosis of the clinically non- specific nodules is brought (erythema nodosum, abscess, erythema induratum, lupus profundus, Weber-Christian disease, or cutaneous metastases) but only one type of lobular and septal panniculitis without vasculitis is typi- cally associated to severe pancreatic disease and then called pancreatic panniculitis (1). Clinically the subcuta- neous lesions are painful in about 50% of the cases, requiring analgesics and often precede the clinical symp- toms of pancreatitis (2). They present more typically on the lower limbs but they can also occur on any other part of the body : trunk, abdomen (Fig. 1), arms, thighs and buttocks (Fig. 2).
ERCP in patients with jaboulay pyloroplasty
Endoscopic retrograde cholangiopancreatography (ERCP) is successfuly performed in a substantial percent of patients with surgically altered gastrointestinal and/or bilio-pancreatic anatomy using an appropriate endoscope and other instruments (1,2). Billroth II gastroenterostomy, Roux-en-Y hepaticojejunostomy, Whipple procedure, gastrojejunal bypass are the most commonly performed examples (Table 1). Access to the papilla must be through an afferent loop using a duodenoscope, gastro- scope, colonoscope, pediatric colonoscope or entero- scope (including balloon enteroscope) (1-7). Jaboulay pyloroplasty (JP) is a side-to-side antroduodenostomy anastomosis aimed to relieve gastric outlet obstruction that is infrequently performed currently (Fig. 1) (8). To our knowledge there is no data in the literature regarding the ERCP interventions in patients with JP. Herein we present our ERCP experience in patients with JP.
Freehand endoscopic lithotripsy for Bouveret's Syndrome
An 81-year-old female patient was admitted to our hospital with a 6-day history of abdominal pain and multiple episodes of vomiting. Abdominal CT showed an extensive pneumobilia, a contracted gallbladder that communicated with the duodenum, and an ovoid, calci- fied mass in duodenal bulb. At the esophagogastroduo- denoscopy, a large calculus was seen in the duodenal bulb (Fig. 1).
Gastrointestinal stromal tumor in the duodenal blind spot : role of pediatric colonoscope and endoscopic ultrasound
We read the article titled "An unusual cause of upper gastrointestinal bleeding : duodenal GIST. A case report and literature review" published in June 2011 issue of Acta Gastro-Enterologica Belgica with much inter- est (1). Gastrointestinal stromal tumors (GIST) account for 0.1-3% of gastrointestinal tumors with an annual incidence of 10-15 per million people (2). Mostly pre- senting as gastrointestinal bleeding (GIB), over two- thirds of GISTs are located in stomach and, therefore, easily detected with a gastroscope.
An infrequent variant of Stauffer's syndrome
Cholestasis could be a paraneoplastic manifestation of underlying malignancies. Stauffer's syndrome is a rare paraneoplastic manifestation of renal cell carcinoma characterized by abnormal liver enzymes and usually without hepatic metastasis and jaundice. Little is known about the cholestatic variant of Stauffer's syndrome. Stauffer's syndrome variant is reported as one of the unusual presentations.
