Volume 87 - 2024 - Fasc.3 - Case reports
Isolated intestinal manifestation of an invasive varicella zoster virus reactivation in an immunocompromised patient: a case report
Invasive varicella zoster infection is a rare but severe
infectious disease, potentially affecting almost every organ
system and presenting with a variety of symptoms. It is usually
seen in immunocompromised patients, but also occurs in
immunocompetent patients. Isolated intestinal manifestations
without skin lesions are even more scarce. We present a case
of a 78-year old immunocompromised man with an isolated
intestinal Varicella Zoster reactivation. If not early diagnosed
and treated, an invasive infection can lead to life-threatening
complications. Therefore, awareness in both immunocompromised
as immunocompetent patients is very important in the daily clinical
practice.
Combination therapy based on SpyGlass-guided electrohydraulic lithotripsy through cholecystoduodenostomy by lumen-apposing metal stent (SLAMS) for Mirizzi syndrome
Mirizzi syndrome is a rare complication of chronic gallstone
disease characterised by the compression of the common bile
duct due to an impacted lithiasis in the infundibulum of the
gallbladder or cystic duct. In this case study, we discuss an 85-yearold
patient who presented with Mirizzi syndrome associated with
septic shock. She was not eligible for cholecystectomy due to her
advanced age and frailty, requiring a less invasive alternative.
Gallbladder drainage was initiated by endoscopic ultrasoundguided
cholecystoduodenostomy with a lumen-apposing metal
stent (LAMS). Utilising this bulbo-cholecystic stent, SpyGlassguided
electrohydraulic lithotripsy (SGEHL) was then performed,
resulting in successful extraction of multiple bile stones, including
a 20 mm lithiasis that was lodged in the cystic infundibulum.
Subsequently, serum bilirubin levels and inflammatory markers
were significantly reduced, consistent with resolution of Mirizzi
syndrome. The combination of SGEHL and LAMS, designated as
SLAMS, represents a novel, minimally invasive intervention for
this potentially life-threatening disease.
Small bowel obstruction on food impaction after binge eating
Small bowel obstruction is a relatively prevalent surgical
condition, with the most common underlying cause being
postoperative adhesions. However, in patients with no previous
history of abdominal surgery, one needs to think more outside
the box. In this case study, we have a young and athletic man who
presented to the emergency department with an acute abdomen,
shortly after binge eating a large amount of food. Obstruction
due to food impaction, such as in our case, should always be on
the differential list, especially in those without significant medical
history and with binge eating pattern where uncontrolled and
extreme amounts of food are eaten alternating with restrictive
dieting.
An unusual case of high gastrointestinal bleeding after Whipple surgery
Pancreatic cancer is an aggressive malignancy with poor
survival rates. Pancreatic surgery has improved outcomes in the
last few decades, but still contains high morbidity rates. Pancreatic
fistula, delayed gastric emptying, intra-abdominal infections and
bleeding are well-known complications. We report a case of a
57-year old woman with a portogastric fistula complicated with
high gastrointestinal bleeding and septic thrombophlebitis after
pancreaticoduodenectomy for pancreatic adenocarcinoma.
