Volume 81 - 2018 - Fasc.2 - Case reports
Eikenella corrodens perirenal abscess resulting from a pancreatic fistula in a patient with chronic pancreatitis. Case report and literature review
We present a case of a right perirenal Eikenella corrodens abscess in a patient with chronic pancreatitis and poor dental hygiene. Endoscopic Retrograde CholangioPancreaticography (ERCP) revealed a pancreatic fistula draining to the right perirenal loge.
The patient was treated with broad-spectrum antibiotics, percutaneous drainage and endoscopic stenting of the duct of Wirsung, stopping the supply of the fistula. A full recovery in our patient was observed.
Considering the uncommon location of the abscess, a review of the different aetiologies of perirenal abscesses and their distrubution patterns, and the endoscopic treatment of symptomatic pancreatic fistulas seemed worthwhile. (Acta gastroenterol. belg., 2018, 81, 323- 326).
A case of unusual histiocytic colitis in a chronic alcoholic obese patient with ankylosing spondylitis
A 64 year-old Caucasian man was first investigated 21 years ago for persistent diarrhoea. A colonoscopy revealed an erosive pancolitis with unusual vacuolated macrophages. Characteristics of ulcerative colitis or Crohn's disease were absent. Similar findings were observed consistently over the following years. A treatment with Sulfasalazine, Methotrexate or Budesonide was efficient. Histiocytic colitis is rare, and the various causes and different diagnoses are reviewed. The cause for the chronic pancolitis in this obese chronic alcoholic remains unknown at the time of writing. Links to the dyslipidaemia and chronic ankylosing spondylitis presented by the patient are possible hypotheses worth investigating further. (Acta gastroenterol. belg., 2018, 81, 327-329).
Favourable long term effect of ursodeoxycholic acid treatment on congenital vanishing bile duct syndromes
Vanishing bile duct syndromes (VBDS) constitute a heterogeneous group of diseases characterized by progressive disappearance of intrahepatic interlobular bile ductules (1). Several conditions have been related with VBDS, both congenital and acquired. Congenital abnormalities include Alagille syndrome, cystic fibrosis, a1 antitrypsin deficiency and progressive familial intrahepatic cholestasis (PFIC), while infections and medications can also cause VBDS later in life (2, 3). PFIC is a group of autosomal recessive disorders of bile formation that present with cholestasis, itching and jaundice (4).
Congenital VBDS lead to chronic cholestasis, development of cirrhosis and death from liver failure (2, 3). Primary biliary cirrhosis (or primary biliary cholangiopathy as has been recently renamed) is probably the best known example of these entities where both inherited and environmental factors are implicated (2). Ursodeoxycholic acid (UDCA) is a hydrophilic dihy- droxy bile acid and is recommended for patients with primary biliary cirrhosis (5). AlsO. UDCA can be used as a treatment for other cholestatic syndromes due to its anticholestatic effects (5). In this article, we report a favorable long term effect of UDCA treatment in two patients with congenital vanishing bile duct syndromes. The first patient has been followed up in our clinic for the last 27 years whereas the second patient was first evaluated eight years ago.
The combination of acute pancreatitis and toxic hepatitis developing secondary to exposure to malathion : a case report
Organophosphate(OPH) compounds are cholinesterase- inhibiting chemicals used as pesticide. Pancreatitis secondary to malathion toxicity is rare and toxic hepatitis has been reported in only one case. In this paper, we report the case of the combination of acute pancreatitis and toxic hepatitis, which developed in a 30-year old farm worker and the mechanism is discussed in this first report of its kind. Awareness of this complication should prompt earlier investigation because early diagnosis coupled with timely therapeutic measures may improve patient prognosis. (Acta gastroenterol. belg., 2018, 81, 333-335).