Volume 88 - 2025 - Fasc.2 - Case reports
Successful Endoscopic Management of Gastric Volvulus: A Case Report Highlighting Effective Treatment Strategies
Gastric volvulus is a rare entity which lacks evidence in
the literature, characterized by the abnormal twisting or
rotation of the stomach on itself of at least 180 degrees along
its transverse or longitudinal axis. This rotation can lead to
the obstruction of the stomach and interfere with its blood
supply, causing a variety of symptoms and potentially serious
complications. Some patients may be managed temporarily
or definitively with conservative or endoscopic treatment, the
latest including reduction and percutaneous gastropexy, but
most patients benefit from surgery. The authors report three
cases of gastric volvulus seen in a six-months period.
A case report on use of TIPS for ectopic variceal bleeding
Background: Ectopic varices may develop anywhere in
the abdomen except in the cardioesophageal junction and
cause only 5% of all variceal bleeding. Considering the low
prevalence of this disease, management is challenging and
low-evidence based. By means of a case report, we reviewed
literature on the treatment of ectopic varices using TIPS
(Transjugular Intrahepatic Portosystemic Shunt).
Case presentation: A 65-year old patient presented to
the emergency department with massive hematochezia
and haemorrhagic shock. A CT angiography reported liver
cirrhosis, a portal vein thrombosis (PVT) and colonic varices
without active bleeding. The patient was transferred to the
intensive care unit where colonoscopy confirmed the presence
of ascending colonic varices with a red whale sign. He
successfully underwent a TIPS placement and was discharged
after five days from the hospital.
Conclusion: In this case, TIPS placement proved to be
an effective treatment for ectopic variceal bleeding.
Atypical presentation of Olmesartan-induced gastritis and enteropathy
Olmesartan is an angiotensin II receptor blocker (ARB)
used for the management of hypertension. We report a case
of Olmesartan-associated severe gastritis and enteropathy
(OAE) in a 81-year-old female patient who presented with
anorexia and weight loss. After discontinuation of the drug,
her symptoms improved and follow-up gastroscopy showed
endoscopic improvement. Histopathology showed a reduction
of eosinophils and intraepithelial lymphocytosis, but a
persisting increase in mast cells. Hence, systemic mastocytosis
was excluded by further investigations. To our knowledge, this
is the first case report of a patient with Olmesartan-associated
severe gastritis with histopathological presence of mast cells.
We conclude that mast cells, like eosinophils, could be druginduced,
although systemic mastocytosis must be ruled out.
Future studies should focus on the link between local mast cells
and gastro-intestinal diseases.
Dupilumab in an adolescent with eosinophilic esophagitis and eosinophilic duodenitis, a valuable treatment option
The authors report the first adolescent (to our knowledge)
in Belgium to receive duplimumab for eosinophilic esophagitis
(EoE) and eosinophilic duodenitis (EoD).
EoE was diagnosed in 2020 in a 13-year-old boy by
endoscopy with biopsies following complaints of abdominal
pain. Several treatments (omeprazole, topical steroids,
and elemental diet) have been tried without adequate and
sustained success. In 2023, in addition to the diagnosis of EoE,
a diagnosis of mucosal EoD with significant ulceration was
established. In January 2023, the EMA approved the use of
dupilumab for EoE in children above the age of 12. Weekly
subcutaneous dupilumab 300mg was started in November
2023. After three months, a complete endoscopic and histologic
normalization of the esophagus and duodenum was achieved.
He reported no further clinical signs or adverse events to date.
