Volume 81 - 2018 - Fasc.4 - Clinical images
Incidentally found abnormal discoloration of ileal mucosa
A 27 year old male was evaluated for ongoing abdominal pain associated with altered bowel habits for past 3 months. Previous investigations including hemogram, liver and kidney function tests were normal. Abdominal computed tomography was also normal. For evaluation of his symptoms, the patient underwent colonoscopy which showed normal colonic mucosa. However the ileal mucosa appeared to be discoloured without any mucosal abnormality (Figure 1). Upper endoscopy also showed similar patchy discoloration in the duodenum.
Aortic thrombosis recurrence in a Crohn's disease patient
A 43 years old women with ileo-colic Crohn's disease (CD) was admitted to Gastroenterology Unit of the S. Orsola Hospital in Bologna (Italy) for abdominal pain due to sub-occlusion related to CD relapse. At admission the patient referred constipation and abdominal swelling without fever since a week. Physical examination and laboratory tests were normal. After that, an abdominal computed tomography (CT) scan was performed.
What are the pathological features present in the Figure? Which could be the diagnosis?
Remarkable dilation of the common bile duct in an elderly patient
A 78-year-old male without relevant medical history was submitted to Endoscopic Retrograde Cholangiopancreatography (ERCP) for acute cholangitis. Prior abdominal CT scan showed excessively dilated common bile duct (CBD) of 35mm and no evidence of choledocholithiasis (Fig. 1a); an abrupt stop in the distal CBD suggesting malignant stricture was also seen (Fig. 1b). Duodenoscopic examination revealed a 20mm sized bulging nodular lesion with congestive and irregular mucosal surface at the major duodenal papilla (Fig.2); ERCP performed showed a distal stricture and CBD with 38mm diameter (Fig. 3).
Is there gold in everything that glitters?
A 46-year-old man with past medical history of cystic fibrosis, submitted to pulmonary transplantation 8 years ago (under triple immunosupression), presented to our emergency department with a several days of profuse, watery diarrhoea (4-5 stools/daily), anorexia, abdominal pain and fever. There were no complaints of blood loss or mucus. Physical examination was unremarkable. Blood work revealed elevated C-reactive protein levels (192.7mg/dL). No changes were noted on abdominal ultrasound. On ileocolonoscopy, florid deep discrete ulcerations in the right colon and ileocecal valve were found. Terminal ileum showed marked erythema. (Figure 1 and 2).