Volume 80 - 2017 - Fasc.3 - Case reports
An unusual cause of severe, persistent diarrhoea
We present two cases of patients with severe persistent diar- rhoea, in whom duodenal biopsies revealed villous atrophy that could be attributed to the use of olmesartan. The differential diagnosis of villous atrophy without serological markers of celiac disease should include drugs as possible cause, with olmesartan as a recently discovered culprit. Gastroenterologist should be aware of this entity. (Acta gastroenterol. belg., 2017, 80, 416-418).
A case of pseudorenal failure - spontaneous rupture of the urinary bladder
A 64-year old woman was admitted to the hospital for severe abdominal pain and distension after gardening and chopping wood the day before. She had a medical history of superficial transitional cell carcinoma (TCC) of the urinary bladder and a laparoscopic nefro-ureterectomy for an invasive TCC of the upper urothelial tract in 2012. Clinical examination showed an acute abdomen. Laboratory analysis revealed a plasma creatinine level of 4,23 mg/dl. Computed tomography (CT) imaging of the abdomen showed hypodense free intraperitoneal fluid, suspicious for ascites. Serum creatinine level decreased to 1.8 mg/dl after placement of a urinary catheter. Laparoscopic exploration revealed a perforated ulcer in the urinary bladder dome, the intraperitoneal fluid showed abnormally high levels of urea and creatinine, confirming uroperitoneum. This case shows that uroperitoneum must be in- cluded in the differential diagnosis of patients with diffuse/acute abdominal pain, abdominal distension and elevated levels of serum creatinine, and that vigilance is indicated. (Acta gastroenterol. belg., 2017, 80, 419-421).
Jaundice in a pregnant woman
A 34-year-old woman in the 22nd week of gestation presented with generalized pruritis and weight loss since the first trimester of pregnancy. Physical examination revealed cutaneous scratch lesions, jaundice, and hepatomegaly. Blood tests revealed cholestasis with elevated direct bilirubinemia. Auto-antibody and viral hepatitis tests were negative. Liver ultrasound was normal. The initial diagnosis was cholestasis of pregnancy. However despite treatment with ursodeoxycholic acid, the patient did not improve. Delivery was by cesarean section at the 26th week of pregnancy for obstetrical reasons. A new liver ultrasound showed a heterogeneous nodular mass. Nuclear magnetic resonance (NMR) of the liver showed an 11-cm mass centered on the hilum, dilated intrahepatic bile ducts, involvement of the hepatic veins, and hilar adenopathy. A liver biopsy revealed fibrolamellar hepatocellular carcinoma (FHC). (Acta gastroenterol. belg., 2017, 80, 422-424).
Cholestatic hepatitis after diagnostic ajmaline challenge
We report a cholestatic hepatitis in an elderly woman after ajmaline challenge during electrophysiological testing for Brugada syndrome. No other medication was reported in the previous 6 months of the onset of jaundice. Liver biopsy showed a choles- tatic hepatitis with mild biliary damage. Liver enzymes normalized within 2 weeks as well as jaundice. To the best of our knowledge this is the second case of histologically proved cholestatic hepatitis induced by intravenous ajmaline testing. (Acta gastroenterol. belg., 2017, 80, 425-426).