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Volume 68 - 2005 - Fasc.1 - Case reports

Case report : acute pancreatitis induced by Clozapine

Two percent of acute pancreatitis are drug induced. In the pre- sent paper, we reported the case of a 39 year-old patient with chronic-hallucinatory schizophrenia who developed symptomatic pancreatitis during the clozapine dose titration performed to reach the therapeutic range. Diagnosis of pancreatitis was sug- gested by clinical examination and abnormal laboratory values of pancreatic enzymes and confirmed by C-T scan and ultrasono- graphy. The causal incrimination of clozapine in this case seems likely as all other possible causes of pancreatitis were excluded, as AP developed shortly after the introduction of the drug and as the pancreatic enzymes normalized after clozapine was stopped. No rechallenge to confirm the causal relationship was however attempted. So far, only eight cases of acute pancreatitis have been reported in association with clozapine use. Clozapine is an atypi- cal antipsychotic drug which belongs to the chemical class of dibenzodiazepines. The mechanism by which clozapine could produce acute pancreatitis remained unclear. Nevertheless, we advocate a careful biological follow-up (measuring periodically the concentrations of amylase, lipase and triglycerides) during the treatment by clozapine. (Acta gastroenterol. belg., 2005, 68, 92-94).


Case report : duodenal stromal tumor

Tumors of the small intestine are rare lesions, but they should be kept in mind as possible causes of gastrointestinal symptoms. Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the digestive tract. A 78 year-old woman complaining of abdominal pain, nausea and vomiting after meal and weight loss for three months was admitted to our clinic. On physical examination, there was only epigastric tenderness. No mass was palpated. She was anemic and total protein and albumin levels were low. Other laboratory tests were normal. A 9.0 ?? 7.5 cm heterogeneous mass was detected on the abdominal computerized tomography scan. Endoscopy con- firmed a polypoid and vegetative mass in the second part of the duodenum. Histopathological diagnosis of endoscopic biopsy was gastrointestinal stromal tumor. Pancreaticoduodenectomy was performed. On the 11th postoperative day, relaparotomy was per- formed due to biliary leakage from the subhepatic drain. Biliary leakage was from the choledochojejunostomy. Choledocho- jejunostomy and pancreaticojejunostomy were revised. She was discharged on the postoperative 25th day. Histopathological exami- nation of the resection specimen revealed duodenal stromal tumor. Although stromal tumors are relatively rare in the duodenum, in the case of upper gastrointestinal obstruction and anemia, this type of tumors should be considered in differential diagnosis. (Acta gastroenterol. belg., 2005, 68, 95-97).


Development of adenocarcinoma in chronic fistula in Crohn's disease

The authors report the case of a 55 yr-old woman suffering from Crohn's disease since 31 years with stricture and fistulas developed in the ileocolic junction and anorectal portion. Long- standing anorectal fistulas and stricture led to adenocarcinoma and finally fistulisation in the vagina. Diagnosis was made by per- ineal examination with biopsies under general anaesthesia. Treatment was first posterior pelvectomy with resection of the anterior wall of vagina. Secondarily, radiochemotherapy was administrated. The authors discuss the incidence and risk factors of carcinoma in Crohn's disease with chronic fistulas. (Acta gastro- enterol. belg., 2005, 68, 98-100).


Spontaneous regression of inflammatory pseudotumor of the liver : a case report

Inflammatory pseudotumor of the liver is a rare benign mass that is often misdiagnosed as hepatocellu- lar carcinoma or hepatic abcess. It is a benign entity of unknown origin : etiology and pathogenesis remain unclear, but it is speculated that this tumour is a reactive inflammatory condition (1). The lesion is characterized by encapsulated pro- liferating connective tissue admixed with lymphocytes, macrophages and granular leukocytes (2). Clinical pre- sentation and morphological appearance may vary (3,4). Different kind of treatment have been proposed. In the vast majority of the cases, a surgical excision has been performed and in other cases a conservative treatment (antibiotics or steroids) has been given (1,5). However, the need to treat this lesion has not been fully demon- strated and until now, only few cases of spontaneous regression have been recently described (6-9). The purpose of this report is to present a new case of inflammatory pseudotumor of the liver regressing spon- taneously.


Therapy of acute hepatitis C with interferon-a2b plus ribavirin in a health care worker

Hepatitis C virus can be transmitted to health care workers through needlestick accidents. In this report, the result of short- term therapy with interferon-a2b plus ribavirin combination of acute hepatitis C in a health care worker who infected through laboratory accident was presented. The patient received combina- tion of interferon-a2b (5 MU three times a week) plus ribavirin (1000 mg daily) for three months. Aminotransferase levels were normalised and clearance of HCV RNA was obtained in the first month of the therapy. After 19 months of follow-up, he had unde- tectable levels of HCV RNA so sustained response (clearance of HCV RNA and normalisation of aminotransferases at least six months after cessation of therapy) was achieved. According to this result, short-term therapy of acute hepatitis C with interferon-a2b plus ribavirin may be an alternate to others. (Acta gastroenterol. belg., 2005, 68, 104-106).