Volume 74 - 2011 - Fasc.1 - Case reports
Acute kidney injury after use of oral Fleet Phospho Soda as bowel preparation for colonoscopy
We present a case of a 64-year old woman who developed acute kidney injury (AKI) finally resulting in stage 4 chronic kidney dis- ease after ingestion of a high phosphate containing solution (oral Fleet Phospho Soda) as bowel cleansing for colonoscopy. (Acta gastroenterol. belg., 2011, 74, 77-78).
Esophageal carcinoma presenting with pyopneumothorax : a case study
We describe a 69-year-old male who presented with high fever, progressive right chest pain and shortness of breath. A chest radio- graph showed a right massive hydropneumothorax. After diagnos- tic assessment, an esophagomediastinal fistula complicated by squamous cell carcinoma of the esophagus was subsequently con- firmed. Clinical signs were significantly improved by chest tube insertion, antibiotic therapy and esophageal stent implantation. (Acta gastroenterol. belg., 2011, 74, 79-81).
Repetitive episodes of cryptogenic septicaemia in a patient with cirrhosis : a case of “heavy metal"
Endotipsitis or primary infection of a TIPS-stent, is an uncommon but possible life- threatening condition by its potential evolution to sepsis and death.
Diagnosis should be suspected in patients with a TIPS-stent presenting with stent-dysfunction associated with fever or relaps- ing episodes of bacteremia/sepsis without any other alternative focus.
A certain diagnosis is made by post-factum histopathological and/or microbiological examination of the TIPS-stent which is only possible after liver transplantation or at autopsy, whereas it can be highly suspected in case of repetitive positive blood-cultures without any other focus in a patient with a TIPS-stent.
The microorganisms responsible for endotipsitis are most frequently of Gram-negative enteric origin. The regimen and duration of the treatment should be individualized and depends on multiple factors like the antibiotic sensitivity of the organism and the patients condition. In case of a fungal infection, longer treat- ment is recommended. (Acta gastroenterol. belg., 2011, 74, 82-87).
Faecal incontinence due to atrophy of the anal sphincter in myotonic dystrophy : a case report
Myotonic dystrophy or Steinert disease is an autosomal domi- nant multisystemic disorder with variable penetrance. The genetic defect is an amplified trinucleotide repeat in the 3-prime untrans- lated region of a proteinkinase gene on chromosome 19. Severity of symptoms increases with the number of repeats. Patients with myotonic dystrophy often present with gastrointestinal motility problems, such as intermittent diarrhoea, constipation, and also faecal incontinence. The underlying physiopathological mechanism of faecal incontinence differs from classic soiling due to faecal retention. We present a girl with congenital myotonic dystrophy and faecal incontinence due to anal sphincter atrophy ; and give an overview of present knowledge on the pathophysiology of gastro- intestinal problems associated with myotonic dystrophy. (Acta gastroenterol. belg., 2011, 74, 88-90).
Mediterranean spotted fever presenting as an acute pancreatitis
Mediterranean spotted fever (MSF) is an infectious disease, caused by Rickettsia conorii. It can have a serious course, even deadly, with many types of complications. Described is a case of a 70-year-old man, hospitalized for fever, abdominal pain, amylase and lipase elevation, and ultrasound hypoechoic pancreas. The working diagnosis at admission was acute pancreatitis. 2 days after admission, the patient developed signs of MSF : fever, maculo- papular rash, and "tache noire". Treatment with oral doxycycline was started. After 5 days of therapy, there was complete remission of epigastric pain and fever. Gastrointestinal and hepatic complica- tions are described in association with Mediterranean spotted fever. Much more rare is pancreatic involvement. (Acta gastro- enterol. belg., 2011, 74, 91-92).