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Volume 62 - 1999 - Fasc.2 - Case reports

Ruptured primary splenic angiosarcoma into the colon. Presentation as anal bleeding

A 71-year-old woman presented with a six month history of constipation and abdominal discomfort, with anal bleeding during the last days. Ultrasonography and CT-scan of the abdomen showed a large heterogeneous mass that was located in the splenic region, but the nature and origin of the tumour could not be clearly established preoperatively. The clinical diagnosis was of abdominal tumour with colonic and splenic involvement, and a left helwcolectomy and splenectomy were performed. Pathologic examination revealed a primary angiosarcoma of the spleen with penetration and fistulization of the tumour into the large bowel. The patient received adjuvant radiation therapy, but she died of extensive metastastic disease from her primary angiosarcoma of the spleen nine months after surgery. In summary, spienic angiosarcoma is very difficult to diagnose preoperatively. This highly aggressive neoplasm has an overall poor prognosis, specially if it is associated with rupture and haemoperitoneum. As this case highlights, unusual forms of rupture may lead to atypical clinical presentations, increasing even more the ffimcufty in the diagnosis.


Intragastric intussusception - a curiosity

A case of a 53-year-old man with an intragastric intussuscepted small bowel segment is presented. The patient had previously been operated on for recurrent bleeding gastric ulcers. A discussion is presented on the unusual aspects of the intussusception.


Meloxicam-induced liver toxicity

We report the case of a female patient with rheumatoid arthritis who developed acute cytolytic hepatitis due to meloxicam. Recently introduced in Belgium, meloxicam is the first nonsteroidal antiinliammatory drug with selective action on the inducible form of cyclooxygenase 2. The acute cytolytic hepatitis occurred rapidly after meloxicam administration and was associated with the development of antinuclear antibodies suggesting a hypersensitivity mechanism. This first case of meloxicam related liver toxicity demonstrates the potential of this drug to induce hepatic damage.