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Volume 73 - 2010 - Fasc.2 - Case reports

Papillary adenoma of the extrahepatic biliary tract - a rare cause of obstructive jaundice

The authors present a case of papillary adenoma of the extra- hepatic biliary tract presenting as obstructive jaundice. The diagnosis was based on the endoscopic retrograde cholangio- pancreatography (ERCP), and above all cholangioscopy findings. The patient was treated by bile duct resection with Roux-en-Y hepaticojejunostomy. Adenoma of the bile duct is a rare entity. Only a few cases have been described in the world literature so far. (Acta gastroenterol. belg., 2010, 73, 270-273).


Management of rectal foreign bodies

The presence of foreign bodies inserted into the rectum is not an uncommon situation. Precise guidelines for the management and extraction of these foreign bodies are not frequently described in the literature. Anal access, whether endoscopic or surgical, varies depending on the type of foreign bodies, their size and morphology, and their location in the lower digestive tract. In this report, we describe a case of three rectal foreign bodies that necessitated a mixed endoscopic and surgical approach, and provide a review of the literature. (Acta gastroenterol. belg., 2010, 73, 274-277).


Liver tuberculosis mistaken for malignancy The role of needle biopsy

Despite advances in imaging techniques rare or atypical liver lesions still pose a diagnostic challenge. In many centres percuta- neous fine needle aspiration cytology or biopsy is routinely per- formed in order to obtain a definitive diagnosis. However because of the risk of tumour seeding along the needle tract this attitude may jeopardize the patient's chances for cure in case of malignan- cy. The role of percutaneous liver biopsy is reappraised in the light of an observation in which major hepatectomy was performed for suspected neoplasia only to discover at pathology that the lesion was a benign tuberculosis pseudotumour. (Acta gastroenterol. belg., 2010, 73, 278-279).


Primary aortoenteric fistula caused by an infected abdominal aortic aneurysm with Mycobacterium Avium Complex in an HIV patient

Primary aortoenteric fistula (PAEF) is a rare but complex clini- cal entity requiring multimodality approach for diagnosis and treatment. We report the first ever case of upper gastrointestinal (UGI) hemorrhage caused by an aortoenteric fistula (AEF) second- ary to mycobacterium avium complex (MAC) in a patient with human immunodeficiency virus (HIV) infection. Esophagogastro- duodenoscopy (EGD) showed an ulcer in the distal duodenum and a computed tomography (CT) scan confirmed a contained abdom- inal aortic aneurysm (AAA) rupture with an aorto-enteric fistula communicating with the third portion of the duodenum. Emergent surgery was undertaken which was lifesaving. A high index of suspicion, early diagnosis and prompt surgical intervention are crucial for survival of patient with PAEF. (Acta gastroenterol. belg., 2010, 73, 280-283).


Zinc and biotin deficiencies after pancreaticoduodenectomy

We report zinc and biotin deficiencies after pancreatico- duodenectomy in a 16 year old female presenting clinically with marked alopecia, total body hair loss, dry skin with scales, and maculopathy with significant vision loss. These micronutrient defi- ciencies likely occurred due to resection of the duodenum and proximal jejunum, sites of primary absorption of several micro- nutrients and their protein carriers, including zinc and biotin. Early diagnosis is essential to prevent irreversible sequelae. Adequate supplementation of zinc and biotin as well as dietary advice is needed for clinical improvement. (Acta gastroenterol. belg., 2010, 73, 283-286).


Megaduodenum : an unusual presentation of amyloidosis ?

Amyloidosis, a potentially fatal disease, is characterized by an abnormal deposition of autologous proteins. Heart, liver, kidneys, lung, thyroid, skin and the gastrointestinal tract can be involved ; in this last case mucosal alterations or disturbances of the motility leading to pseudo-obstruction, bleeding, diarrhea and malabsorp- tion can be present. However, the data concerning the possible gastrointestinal presentations of amyloidosis are scanty and heterogeneous. We report the case of a patient presenting severe gastrointestinal symptoms caused by a megaduodenum. The patient was thoroughly investigated and lesions appeared limited to the upper gastrointestinal tract in the absence of a systemic disorder. However, at follow up the patient developed cardiac dilatation and bioptic samples revealed the presence of amyloidosis. (Acta gastro- enterol. belg., 2010, 73, 287-291).