Volume 83 - 2020 - Fasc.2 - Case reports
Boerhaave’s syndrome initially presented with sore throat and cough complicated by a bilateral pneumothorax
A 14-year-old male was admitted to the Emergency Department with sore throat and cough. One hour after his admission, he presented a hemodynamic compromise with a respiratory failure. The thoracic tomodensitometry highlighted a tension bilateral pneumothorax and mediastinum consecutive to an esophageal rupture in the left posterolateral wall also known as Boerhaave’s syndrome which was treated successfully with a non-operative management. To avoid a recurrence of bilateral pneumothorax, a left pleuroscopy with talc pleurodesis was performed. (Acta gastroenterol. belg., 2020, 83, 322-324).
A rectal metastasis of an unknown lobular breast carcinoma and its management
Breast cancer is the most common cancer in women but gastro- intestinal metastases of breast cancer are rare. They can occur years after the diagnosis or at the diagnosis of breast cancer. We report the case of a patient complaining of dyschesia, tenesmus and anal incontinence leading to the discovery of a rectal metastasis of an unknown breast neoplasia. Given the oligo-metastatic condition, multidisciplinary and aggressive management was the chosen therapy. (Acta gastroenterol. belg., 2020, 83, 327-330).
Transjugular intrahepatic portosystemic shunt placement for symptomatic non- bleeding anorectal varices in nodular regenerative hyperplasia
In this paper we present the case of a male 55-year old patient with known ulcerative colitis and nodular regenerative hyperplasia, a rare form of noncirrhotic portal hypertension. He presented four visits to the emergency department with rapidly progressive anal discomfort. After two weeks a transjugular intrahepatic portosystemic shunt was placed using the gun-sight technique with immediate relief of the unbearable anal pain and pressure.
To our knowledge, this is the first case where transjugular intrahepatic portosystemic shunt placement is applied for non- bleeding, congestive anorectal varices. (Acta gastroenterol. belg., 2020, 83, 331-333).
Travel history can make the difference
Entamoeba histolytica infections are rare in developed countries such as Belgium. A 53-year-old female patient presented with 10 days of fever and mild persisting pain in the right hypochondriac despite 6 days of antibiotic therapy. The anamnesis further revealed that the patient was born in Colombia and visits her native country on a regular basis. An abdominal CT-scan demonstrated a large hepatic abscess of 10×8 cm. The diagnosis of Entamoeba histolytica- infection was confirmed with real-time PCR (RT-PCR) from the aspirated material of the abscess. Remarkably, a half year ago, this patient also presented to the gastro-enterology consultation with intermittent rectal bleeding, loose stools and abdominal discomfort. Rectosigmoidoscopy at that time showed sigmoiddiverticulosis and biopsies were taken. RT-PCR on this material was performed during this second episode and was positive for E. histolytica, confirming an episode of amoebic colitis a half year prior to the discovery of the liver abscess. (Acta gastroenterol. belg., 2020, 83, 334-336)