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Volume 79 - 2016 - Fasc.2 - Case reports

Uncommon cause of retrosternal pain

We present the case of a 54-year old male patient who was ad- mitted with severe acute epigastric pain, vomiting, and inability to eat since three days before admission. After having excluded car- diac and pulmonary emergencies, an oesogastroduodenoscopy was planned and showed a gastric volvulus. The patient was treated surgically allowing gastric decompres- sion, gastropexy and Nissen intervention. We discuss the case and describe the classification, the diagnosis, the etiologies and therapeutic options in acute and chronic gastric volvulus. (Acta gastro-enterol. belg., 2016, 79, 251-253).


Sclerosing mesenteric panniculitis in a young patient : common cause of diagnostic dilemma and treatment refractoriness

Background : Sclerosing mesenteric panniculitis (SMP) is an -idiopathic-chronic-fibroinflammatory-disorder-of-the-intra-abdom- inal fat. Case presentation : Herein, we report a case of SMP, involving the- omentum,- mesentery- and- peri-colic- fat- in- a- 18- year- old- male, who-presented-with-significant-and-recurrent-abdominal-distension for 4.5 years. Computed tomogram revealed ascites, with nodular and- irregular- omental- thickening- and- foci- of- calcification.- Non- specific- radiological- and- histological- features- made- an- accurate -diagnosis-extremely-difficult.- After-a-thorough-work-up-and-exclu- sion of other differentials, diagnosis of a nodular SMP (Weber Christian disease) was given. After showing resistance to chemo- therapeutic agents, slow response was noted with cyclophospha- mide,- followed- by- rapid- symptomatic- improvement- with- mesen- terectomy. Conclusion : SMP is an uncommon benign mesenteric/ omental inflammation,-and-is-a-diagnosis-of-exclusion.-As-treatment-refrac- toriness is common, management should be individualized and continued for a long period. Surgical omentectomy may be helpful. (Acta gastroenterol. belg., 2016, 79, 254-256).


An unusual case of haemolytic uraemic syndrome following endoscopic retro- grade cholangiopancreatography rapidly improved with eculizumab

Atypical haemolytic uraemic syndrome (aHUS) is a rare but life- threatening complement system-related disorder, characterized by renal failure, non-immune haemolytic anaemia and thrombo- cytopenia. We report on a young woman who developed a pancre- atitis-induced aHUS following a routine procedure of endoscopic retrograde cholangiopancreatography. The patient was succes- sively treated by 2 plasma exchanges with fresh frozen plasma and eculizumab, a monoclonal antibody designed to block terminal complement activation. The last treatment resulted in the immedi- ate improvement of haemolytic parameters and to the definitive suspension of plasma exchanges. This is likely the first description of the use of a complement inhibitor to treat post-pancreatitis aHUS. We discussed treatment options and concluded that eculi- zumab could be a beneficial alternative to plasma exchanges in the management of such complications. (Acta gastroenterol. belg., 2016, 79, 257-261).