Volume 81 - 2018 - Fasc.2 - Clinical images
Beyond colonic neoplasia
An 81-year-old woman with hypertension and type 2 diabetes was admitted to the emergency department complaining of 2-months abdominal pain without fever, weight loss or abdominal trauma. Physical exami- nation revealed a large palpable mass at the right iliac fossa. Laboratory parameters showed microcytic normochromic anaemia (haemoglobin:10.1g/dL) with normal white blood cell count (8.9x109/L) and C-reactive protein (0.49; N<0.5mg/dL). Plain abdominal X-ray showed no air-fluid levels or pneumoperitoneum. Abdominal ultrasonography was performed revealing a 9cm heterogeneous thickening of the mesenteric fat of the anterior abdominal wall at the right iliac fossa. Tumor markers (CEA and CA 19.9) were normal. Abdo- minopelvic computed tomography revealed a 10cm lesion at the right abdominal wall involving the ascending colon (Figure 1-A,B). Colonoscopy was performed with an intense cecum deformation with mucosal congestion (Figure 1-C).
An uncommon cause of overt small bowel bleeding
An 84-year-old man with atrial fibrillation under Dabigatran and surgically-resected colorectal neo- plasia was admitted with 1-day hematochezia with hemodynamic stability. His past medical history was relevant for intermittent hematochezia episodes over several months with inconclusive conventional endoscopic study. Laboratory analysis revealed severe iron-deficiency anemia (Hg-5.4 (N:13-17g/dL)), aPTT 54.8 (N:25-34seconds) and INR 1.56. Upper and lower gastrointestinal endoscopy were non-diagnostic. A small bowel capsule endoscopy was performed showing a subepithelial lesion at the proximal jejunum (Fig. 1A). Subsequent antegrade double-balloon enteroscopy confirmed the presence of a caterpillar-shaped subepithelial lesion at the proximal jejunum with 20mm in diameter (Fig. 1B), which was tattooed with SPOT® (GI Supply, Camphill, PA, USA).
A rare cause of rectal bleeding
A 65 year-old-woman with a prior history of diabetes mellitus, heart failure and atrial fibrillation, was referred to our endoscopy unit because of rectal bleeding. Digital examination of the rectum revealed a firm, nonobstructing mass near the anal verge. Rectosigmoidoscopy showed a 3cm, blackish mass which is located next to internal hemorrhoids, and just above the dentate line (Figure 1). Biopsy of the mass lesion was performed. Bleeding after biopsy procedure was controlled by argon plasma coagulation therapy.