Volume 73 - 2010 - Fasc.4 - Case reports
Esophageal fibrovascular polyp removed by cervical esophagotomy
We report a case of esophageal fibrovascular polyp (FVP) removed by cervical esophagotomy. The patient was a 74-year-old man in whom an intraesophageal mass was detected by a chest CT examination during a complete medical check-up. An upper gastrointestinal series showed a large, pedunculated, cervical esophageal mass for which our preoperative diagnosis was a FVP. We studied its features, as well as removal procedures in 45 patients in the literature. Most patients had marked symptoms, but ours had no complaints, and so this case may be a rare one. Various removal procedures were reported, but thoracotomy and esophagectomy are considered to be the inappropriate procedures since FVP is a benign disorder. (Acta gastroenterol. belg., 2010, 73, 514-516).
A two-year old boy with recurrent bouts of acute abdominal pain
In a small number of patients with pancreas divisum (with stenotic minor papilla) a relative obstruction to pancreatic exocrine secretory flow results in pancreatitis.
We report a 2-year-old boy presenting with recurrent bouts of abdominal pain. The diagnosis of acute pancreatitis was made based on blood biochemistry results. Ultrasound, computed tomography and magnetic resonance imaging showed several abdominal pseudocysts, peritoneal exsudate and confirmed pancreatitis but initially failed to reveal the aetiology. Ascites and cysts contained pancreatic enzymes. After weeks of combined conservative and surgical treatment, a magnetic resonance cholangiopancreaticography with secretin, showed a pancreas divisum with a cyst between the ducts of Santorini and Wirsung. Based on these findings, two endoscopic papillotomies (minor and major papilla) were performed. Three years follow-up was uneventful. In a child with recurrent pancreatitis or pancreatitis with chronic recurrent abdominal pain it is crucial to search aggressively for congenital abnormalities, including pancreas divisum. Secretin-enhanced magnetic resonance cholangio- pancreaticography or diffusion-weighted magnetic resonance imaging is a valuable diagnostic tool for visualizing pancreatic duct anatomy. (Acta gastroenterol. belg., 2010, 73, 517-520).
Idiopathic portal hypertension during a catastrophic attack in a patient with primary antiphospholipid syndrome
A 43-year old male patient with hyponatremic hypertensive syn- drome was diagnosed as catastrophic primary antiphospholipid syndrome (PAPS). He subsequently developed hepatospleno- megaly. The patient also carried thrombophilia- and haemochro- matosis-associated gene mutations. Further investigations upon persistence of splenomegaly indicated development of idiopathic portal hypertension. (Acta gastroenterol. belg., 2010, 73, 521-526).
Ingested toothpick fistula of the ileum mimicking Crohn's disease
Foreign body ingestion is an accidental or an intentional event, with most of the ingested foreign bodies passing spontaneously through the gastrointestinal tract without incidents. About 10-20% of them, especially long and sharp objects like toothpicks, will fail to pass through the entire gastrointestinal tract and may cause symptoms. Toothpick injury of the gastrointestinal tract is often associated with considerable morbidity and mortality. The compli- cations that can be caused by toothpick ingestion are obstruction, perforation, hemorrhage, fistula formation, small bowel inflamma- tion, sepsis and even death. Diagnosis of toothpick injury can be difficult as there are no specific physical findings or laboratory examinations which may aid the diagnosis and even imaging stud- ies are of little help as wooden toothpicks are radiolucent. We report a rare case of incidental toothpick ingestion which caused an ileum fistula and mimicked Crohn's disease. (Acta gastroenterol. belg., 2010, 73, 527-529).
Dilated cardiomyopathy in celiac disease : role of carnitine deficiency
Celiac disease (CD) is an immune-mediated enteropathy in genetically susceptible persons and the disease can present with manifestations in the intestine and in organs outside the gut. An increased prevalence of CD in patients with idiopathic dilated cardiomyopathy or secondary cardiomyopathy and some other cardiac disorders has been reported. Here is described a case of dilated cardiomyopathy in a patient with CD and secondary carni- tine deficiency. Dilated cardiomyopathy due to carnitine deficiency may occur in CD patients and carnitine deficiency may present not only at the time of diagnosis of CD but it may also develop during gluten-free diet, particularly in patients with fast weight gain and without carnitine supplementation. (Acta gastroenterol. belg., 2010, 73, 530-531).