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Volume 74 - 2011 - Fasc.3 - Case reports

Acute adult intussusception caused by primary cecal non Hodgkin lymphoma

Intussusception of the bowel is rather rare in adults and in about 80-90% of the cases is secondary to an underlying intraluminal pathology that serves as a lead point. In cases of colonic intussus- ception malignancy occurs in 63-66% of patients and it is usually adenocarcinoma and rarely lymphoma. The presenting symptoms are non specific and are in most cases of long duration, consistent with a chronic intussusception causing partial intestinal obstruc- tion. We present a rare case of primary colorectal lymphoma in a 29 years old female that was complicated by acute ileocecal intus- susception, treated with en bloc resection without reduction. (Acta gastroenterol. belg., 2011, 74, 451-453).


Macroscopic endoscopic lesions in microscopic collagenous colitis : double case report and review of the literature

Collagenous colitis is a cause of chronic diarrhea of incompletely elucidated origin, defined by normal laboratory tests, a normal endoscopic appearance of colonic mucosa and specific microscopic inflammatory features on colonic biopsies. We report two cases of macroscopic endoscopic lesions observed in patients suffering from chronic diarrhea, whose biopsies confirmed a diagnosis of collage- nous colitis and who were successfully treated in that setting, achieving clinical and endoscopic remissions. By means of a litera- ture review, we summarize what is known about collagenous colitis. We particularly discuss macroscopic findings in that con- text, drawing attention on the so called "microscopic colitis" in the differential diagnosis of that type of lesions. (Acta gastroenterol. belg., 2011, 74, 454-461).


Anaphylactic shock as a single presentation of Echinococcus cyst

We describe the case of a 14-year-old boy of Turkish origin, pre- senting with anaphylactic shock after a minor abdominal trauma. Further investigations revealed a hepatic Echinococcal cyst with- out evidence of rupture. Anti-helminthic therapy was adminis- tered. Because of aggravating symptoms and recurrent anaphylax- is, surgical excision was performed. Intra-operative, a rupture into the biliary tree was seen. After surgery, the anaphylactic symptoms disappeared and the patient recovered. This case-report supports the fact that anaphylactic shock can be the only presentation of a hydatid cyst. Microscopic spillage can possibly be sufficient to cause major anaphylaxis. (Acta gastroenterol. belg., 2011, 74, 462- 464).


Splenic arteriovenous fistula - late complications of splenectomy

This is a case report of a 30-year-old female patient with a splenic arteriovenous fistula of rare, atypical clinical course. The patient was admitted to the hospital due to strong abdominal pains and fever. 13 years earlier, the patient underwent splenectomy due to post-traumatic rupture of the spleen. On imaging examinations prior to surgery (ultrasonography, CT), a splenic arteriovenous fis- tula was diagnosed. The patient was operated on due to increasing abdominal pain. The fistula was closed by splenic artery and splenic vein banding during the course of laparotomy. This case report will be discussed based on literature review. (Acta gastro- enterol. belg., 2011, 74, 465-467).


Collagenous colitis and collagenous gastritis in a 9 year old girl : a case report and review of the literature

Collagenous gastritis is a rare disease in the general population and collagenous colitis has seldom been reported in children. We report a girl with both diseases and review the literature on this association afetr a systematic search of Pubmed, Medline and Embase databases.. The girl, diagnosed of collagenous colitis at the age of 2 years, started with abdominal pain and anaemia at the age of 9 years and was diagnosed of collagenous gastritis in the gastric biopsies. After review of the literature, we found 66 reported cases (33 children, 33 adults, 68% females), 56 patients with collagenous gastritis and 16 children with collagenous colitis. Both disorders coexisted in 20patients. The main presenting symptoms are abdominal pain and anaemia in patients with collagenous gastritis and diarrhoea and weight loss in patients with both disorders. Hypoalbuminemia was found in 9 patients with both diseases and protein losing enteropathy was demonstrated in 3 cases. Deposits of collagen in the duodenum were observed in 13 of 19 patients with both diseases. Seventeen of 66 patients had associated autoimmune disorders, particularly in patients with both diseases (35%). These conditions have a chronic course but gastric or colonic malignan- cies have not been communicated to date. In conclusion, collage- nous gastritis and collagenous colitis mainly affects women and can occur at any age. Their association is exceptional. These disorders, although rare, should be considered in patients with anaemia and epigastric pain, watery diarrhoea or protein losing enteropathy. (Acta gastroenterol. belg., 2011, 74, 468-474).