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Volume 81 - 2018 - Fasc.4 - Case reports

Gastrostomy placement : when fluoroscopy helps the endoscopist

Background and study aims : Percutaneous endoscopic gastro- stomy is the most common therapeutic procedure performed by the digestive endoscopists in the upper gastrointestinal tract. It aims to feed patients presenting denutrition and/or insufficient oral intake. Percutaneous endoscopic gastrostomy feasibility is about 95-100 % although in some cases it is impossible to achieve it, leading to ask for a surgical placement. Even though the feasibility of the surgical approach is excellent its complications are quite higher than percutaneous endoscopic placement, it requires general anesthesia and sometimes these patients could be non elligible for it due to their comorbidities (malnutrition, cardio-vascular diseases etc.). Another alternative technique is the percutaneous radiological gastrostomy but this procedure is rarely available in our country. Patients and methods: We described four cases in patients with previous failure of PEG, in which we used an hybrid approach between radiological and endoscopic techniques, allowing the placement of gastrostomy tube, without general anesthesia. Results: This was successfull in all patients and there was no complications related to the procedure. Conclusions : This technique offers an additionnal opportunity to avoid general anesthesia and surgical complications in patients with unfavorable conditions. (Acta gastroenterol. belg., 2018, 81, 525-527).


A rare malformation of the alimentary tract, tailgut cyst : a case report

Tailgut cyst (cystic hamartoma) is a rare congenital pathology that arises -from post-natal primitive gut remnants in the retrorectal-presacral space. Because of the rarity of the lesion and the variability of the anatomical position, its diagnosis and surgical treatment are often difficult. Complete surgical excision of the multilocular and multicystic process prevents recurrent draining sinuses and eliminates the possibility of malignant change. We describe a case in which a tailgut cyst localized in the retrorectal and presacral space was characterized by abscess, repeated urinary tract infection, and rectal pain. (Acta gastroenterol. belg., 2018, 81, 528-530).


The missing link

We present a case of a 28-year old woman who presented with bizarre wheezing breath sounds on expiration and dysphagia, with unexplained significant dilation of the esophagus mimicking achalasia finally leading to the diagnosis of a very small congenital tracheoesophageal fistula (TEF). Congenital TEF is usually detected shortly after birth and is typically accompanied by esophageal atresia. Congenital TEF without esophageal atresia (H-type fistula) can be missed in early life and diagnosis may be postponed until adulthood due to subtle symptoms. Diagnosis is usually based upon a combination of esophagoscopy, bronchoscopy, barium esophagography and CT-scan. The only clue can be the finding of a significant dilated aperistaltic esophagus, with subsequent more detailed CT reconstruction revealing a very tiny H-type TEF. It is important to raise the awareness of small H-type TEF as a possible cause of achalasia-like esophageal dilation in adulthood and of very unusual and bizarre wheezing breath sounds. (Acta gastroenterol. belg., 2018, 81, 531-533).


Meckel's enterolith : a rare cause of mechanical small bowel subobstruction

Meckel's diverticulum is the most common congenital gastrointestinal malformation and may present with bleeding, obstruction and diverticulitis. Symptomatic Meckel's diverticulum is associated with age < 50 years, male gender, diverticular length > 2 cm and ectopic mucosa. Formation of enteroliths is a rare complication of Meckel's diverticulum and the majority of stones will remain in the diverticulum. Factors promoting enterolith formation through precipitation of calcium in the small intestinal alkaline environment include stasis as well as diverticular anatomy and histology. Mechanical obstruction due to liberation of enteroliths is even more rare and other mechanisms include intussusception, adhesions, volvulus and neoplasms. Visualization of enteroliths on plain abdominal films is challenging because not all stones are radiopaque. Surgical diverticulectomy or segmental bowel resection with anastomosis is preferred in case of complications. We present a case of mechanical small bowel sub- obstruction resulting from an expelled Meckel's enterolith. (Acta gastroenterol. belg., 2018, 81, 534-537).