Volume 86 - 2023 - Fasc.4 - Case reports
Watch-an-wait strategy for multiple rectal neuroendocrine tumors with widespread invasion
A 57-year-old man with a history of surgical resection for
subocclusive small bowel Crohn’s disease, was referred for
endoscopic follow-up. Rectal neuroendocrine tumor(rNETs)
was found during screening colonoscopy in the form of a
centimetric polyp. A post-polypectomy endoscopy was reassuring
while random biopsies performed showed low grade multiple
rNETs diffusely infiltrating the mucosa and submucosa. Both
abdominal-pelvic computed tomography (CT) and endoscopic
ultrasonography echoendoscopy (EUS) did not identify any lymph
node or distant lesion. Watch-and-wait strategy was performed by
regular colonoscopy and EUS. As far as we know, this case is the
unique case reported of non-progressive diffuse multiple rectal
neuroendocrine tumors after a very long-term follow-up of 20
years. This case further supports that “Watch and wait” could be a
safe alternative management strategy for selected rNETs, specially
in patients for whom the surgical risk is increased with a potentially
significant impact on the quality of life.
Jejunal bleeding: a case report
Small intestinal bleeding remains a relatively uncommon event,
accounting for 5-10% of all patients presenting with gastrointestinal
bleeding. A rare but significant source includes hemangioma of the
small intestine. Here we present a case of a 78-year-old female patient
admitted with recurrent melena and iron deficiency anemia. After
performing a normal upper and lower endoscopic examination,
we suspected small bowel bleeding. Correspondingly, the patient
underwent a video capsule endoscopy, showing a submucosal
nodular lesion in the distal jejunum. Balloon enteroscopy clearly
identified and inked the lesion, facilitating minimally invasive
surgery. Pathology demonstrated a cavernous hemangioma. As we
did not have a conclusive diagnosis preoperative and endoscopic
intervention may have led to uncontrolled bleeding or perforation,
laparoscopy was chosen to conduct a better evaluation. The present
case findings emphasize that gastrointestinal hemangiomas,
although uncommon, should be considered in the differential
diagnosis of patients who present with unexplained gastrointestinal
bleeding or other abdominal symptoms.
Banknotes in the stomach
In adults, foreign bodies are intentionally or accidentally
ingested and may sometimes cause significant
clinical consequences depending upon their physical
and chemical features (1). Obstruction, perforation and
penetration are the major gastrointestinal complications.
Small and blunt objects mostly pass through the gastrointestinal
system without any difficulties. Objects that
fail to pass require endoscopic or surgical interventions
(2). Endoscopic retrieval is the preferred therapeutic
procedure if the type and location of the foreign body
is relevant. Herein, we report a young refugee whom
deliberately ingested a package of money before failed
migration attempt and admitted to us for money retrieval
from his stomach.
Successful treatment of ulcerative colitis with anakinra: a case report
Currently the effect of IL-1 blockade on ulcerative colitis (UC)
is still ambiguous. This case report describes a patient with UC who
developed severe complications after an episode of azathioprineinduced
pancytopenia including cytomegalovirus pneumonitis,
hemophagocytic lymphohistiocytosis, and probable pulmonary
aspergillosis. Imaging after the hospitalization revealed a severe
disseminated chronic candidiasis and persisting inflammation
was seen. Genetic testing revealed heterozygous variants in NOD2
and NLRP12, and cytokine testing showed an increase in IL-1Ra,
IL-18, CXCL9, and CXCL10. Consequently an IL-1 mediated
autoinflammatory syndrome was suspected. Simultaneously, the
patient developed a corticosteroid dependent UC flare-up.
Treatment with anakinra was initiated for the IL-1 mediated
disease which quickly induced remission of both the inflammatory
syndrome and the UC.
