Volume 75 - 2012 - Fasc.2 - Letters
A rare complication of Henoch-Schönlein Syndrome : gastrointestinal infarction and perforation
We want to report an intestinal perforation with intes- tinal ischemia as a result of fatal complication of Henoch-Schönlein purpura (HSP).
A 39 year old male patient was admitted with 5 days history of abdominal pain, melena and vomiting. Abdominal pain was severe and colicky with vomiting. The patient had respiratory tract infection 2 weeks before admission. He had also edema and pain in both ankles a week before admission. On the next day of admission petechial rashes emerged on posterior of both legs and in front of each tibias. Biopsy samples from rashes were taken. Meanwhile, abdominal, knee and ankle pain worsened. The first laboratory tests revealed the following results : white blood cells 20.4 × 1000/dl, haemoglobin 10.2 gr/dl, thrombocytes count 83 × 1000/L. Abdominal examination disclosed diffuse ten- derness and rebound tenderness. There was severe dis- tension in the abdomen with reduced bowel sounds.
A rare complication of Percutaneous Endoscopic Gastrojejunostomy (PEG-J) : duodenal bulb perforation due to retrograde migration
Jejenum delivery of enteral nutrition with percutaneous endoscopic gastrojejunostomy (PEG-J) is necessary for the patients who are complicated by gastroparesis, gastro- esophageal reflux, gastric resection, pancreatitis, severe aspiration risk, or gastric feeding intolerance (1). We present here a patient with esophagomediastinal fistula, whose nutritional support was maintained through a PEG-J tube which caused a rare complication.
Synchronous hepatocellular carcinoma and sigmoid colon metastasis presenting as liver and intra-abdominal abscesses
Hepatocellular carcinoma (HCC) is a common malig- nant tumor. The reported incidence of clinical HCC with GI tract invasion is 0.5-2% (1), and direct invasion to the colon is extremely rare (2). Extrahepatic metastasis to the distal sigmoid colon has never been reported before
Dilation of a severe biliary stricture by using a guidewire left in place overnight
Endoscopic placement of a biliary stent is frequently used in the treatment and palliation of benign and malig- nant biliary strictures. Dilation of fibrous and tight steno- sis with either a balloon or bougie facilitates stent inser- tion. There is a group of patients in which tight stricture permit passage of only a small caliber guidewire and attempts to dilate with conventional dilators in order to place a stent or nasobiliary drain fail. Using a Soehendra stent retriver or small-caliber angioplasty balloon for dilation and percutaneous or surgical management of the stricture are rescue treatment methods in these patients (1-4). Herein we report the use of a guidewire traversing the stricture and left in place for 24 hours as a dilator in two patients with a severe biliary stricture not traversable by conventional dilators which could be of interest to interventional endoscopists.
Combined endoscopic sphincterotomy and trans-catheter arterial embolization for the treatment and prevention of acute pancreatitis induced by hemobilia from hepatocellular carcinoma
Here, we report a case of hepatocellular carcinoma (HCC) with bile duct invasion and acute pancreatitis. The patient was successfully treated by endoscopic sphincterotomy (ES) and bile duct lavage for hemobilia. Trans-catheter arterial embolization (TAE) was per- formed to stop tumor bleeding and recurrent pancreatitis did not occur anymore during the following 7 years.
