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Volume 75 - 2012 - Fasc.1 - Case reports

A rare case of chronic intussusception due to Non Hodgkin lymphoma

Chronic intussusception is defined as intussusception with a history of more than 14 days and is generally associated with a predisposing factor. We are reporting a rare case of chronic intus- susception due to Non Hodgkin lymphoma of ileum, appendix, caecum and ascending colon presented as acute intestinal obstruc- tion in emergency. Chronic Intussusception is rare in childhood due to Non Hodgkin lymphoma. A five year male child presented with fever, pain abdomen, vomiting, diarrhoea and mass in right flank. Ultrasonography of the abdomen revealed a mass in ileao-caecal region with chronic intussusception which was confirmed on surgery. X ray of the abdomen showed dilated bowel loops. It is very difficult to make diagnosis of intestinal lymphoma on pre-operative investigations. Patient presented with obstruction should be explored as surgery is the treatment of the choice. Diagnosis can be confirmed by histopathologically. In conclusion, a high index of suspicion and appropriate investi- gations (Uss, Barium enema and CT scan) can result in prompt diagnosis. In majority of children the diagnosis is made at laparo- tomy and surgery plays a pivotal role in the management. (Acta gastroenterol. belg., 2012, 75, 42-44).


Ascites : not always the usual suspects

A case report of a 44-year-old woman with an infrequent cause of ascites, i.e. intraperitoneal urine leakage, is presented. Urinary ascites due to spontaneous bladder rupture or fistula after radiation therapy for cervical cancer is not a rare complica- tion and can develop several years after initial treatment. Diagnosis of urinary ascites should be suspected in patients with ascites and a history of radiation therapy for a bladder or a gynae- cological disease. Measurement of urea and creatinine levels in urine, ascites and plasma is a simple and non-invasive diagnostic test. In physiologi- cal conditions, the ascites/plasma creatinine ratio approximates a ratio of one to one. This ratio is elevated to a value of = 5/1 in case of urinary ascites. Although cystoscopy and imaging techniques such as cystogra- phy and computed tomography (with or without cystography) are extremely helpful, definitive diagnosis is frequently based on intra- operative findings, because of the lack of pathognomonic symp- toms or signs. Surgery is the treatment of choice. (Acta gastroenterol. belg., 2012, 75, 45-48).


Polypoid dysplasia in Barrett's Esophagus: case report and qualitative systematic review of the literature

Dysplasia in Barrett's esophagus (BE) occurs as a flat, grossly undetectable lesion. Dysplasia growing as a polypoid lesion in BE is extremely rare. Only a handful of cases are reported in the liter- ature. BE associated polypoid dysplastic lesions have been referred to as "adenomas" because of their histologic similarity to a colonic adenoma. We describe a patient with esophageal polypoid lesion associated with BE and review clinical and pathological features of other cases of BE associated polypoid dysplasia or "adenomas" as reported in the literature. (Acta gastroenterol. belg., 2012, 75, 49- 54).


Mesenteric vein thrombosis treated successfully with ultrasound augmented thrombolysis

Mesenteric vein thrombosis is a potentially fatal condition that is associated with better outcomes with early diagnosis and inter- vention. A 32-year-old-man with Down syndrome presented with abdominal pain and was found to have extensive porto-spleno- mesenteric thrombosis with early bowel ischemia on computed tomography. He was treated successfully with ultrasound aug- mented thrombolysis. Ultrasound can improve efficiency of throm- bolysis, decreasing the time required for thrombolysis by half, decrease thrombolytic dose and monitoring time and thus reduce overall costs and complications seen with long thrombolysis times. (Acta gastroenterol. belg., 2012, 75, 55-57).


Infliximab and pediatric stricturing Crohn's disease : a possible alternative to surgery ? Experience of seven cases

Introduction : Infliximab (IFX) is one of the treatments of choice for the different phenotypes of pediatric Crohn's disease (CD). Although it was initially feared that anti-TNFa treatment might cause bowel stenosis, recent studies have validated the efficacy of IFX as an anti-stricturing agent. Aim : To assess the efficacy of IFX treatment for pediatric stricturing CD. Patients and methods : Data were obtained on pediatric patients treated at our tertiary level Pediatrics Department (years 2000- 2010). Indications for IFX therapy included persistent disease activity (PCDAI > 20) unresponsive to corticosteroids and thiopurines. All patients treated with IFX underwent upper and lower intestinal endoscopy, abdominal ultrasound and magnetic resonance enterography. Case series : Among 44 pediatric CD patients, 21 were treated with IFX. Seven of these cases had luminal strictures and in 6 patients the inflammatory strictures disappeared after treatment with IFX. One child with ileal fibrotic stenosis (MR) required a surgical resection. Conclusion : Our data support the efficacy of IFX in pediatric CD, including the stricturing phenotype. (Acta gastroenterol. belg., 2012, 75, 58-60).