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Volume 80 - 2017 - Fasc.3 - Letters

A Rare general surgical emergency : small sowel evisceration from vaginal cuff six years after hysterectomy

Vaginal evisceration (VE) is herniation of abdominal contents through a defect in vaginal wall. It is rare and often misdiagnoses when no bowel loops are visible. Prompt diagnosis is necessary to prevent mortality and morbidity due to bowel ischemia and necrosis. We present a patient who applied with severe abdominal pain and underwent surgery because of VE.


Endoscopic submucosal dissection of a schwann cell hamartoma mimicking a lateral spreading tumor of the rectum

We report a case of a 42 years old male with no past medical history or current medication was referred to our outpatient clinic due to rectal bleeding. Physical examination was unremarkable and laboratory data was normal. Colonoscopy showed a 30x15mm flat granular lesion in the rectum, which did not present a typical pattern of adenoma on NBI evaluation. Biopsies were inconclusive for dysplasia and an endoscopic submucosal dissection was then performed with successful en bloc resection of the entire lesion (Fig. 1).


Isolated Pulmonary Valve Vegetations in a Patient with Gastric Lymphoma Diagnosed by Endoscopic Ultrasound

A thirty five year old man presented to the internal medicine department of Cairo University with anorexia, persistent vomiting and progressive weight loss of 2 months duration. The patient is known to be an I.V (intra venous) drug abuser for 6 years; he looked toxic with high grade resistant fever. CBC showed normal leucocytic count with relative PMN leukocytosis and lymphopenia. CRP titer was 179 mg/dl (N:<6mg/dl). The patient was referred for upper endoscopy that revealed mild narrowing at the cardia with exaggerated gastric folds suggesting infiltrating wall disease; however endoscopic biopsies were inconclusive. Due to the high clinical suspicion, EUS and EUS-FNA were done using Pentax EG-3830UT Echo-endoscope, connected to a HITACHI EUB-7000 sonography machine.


Extraction of esophageal foreign body with traction technique via endoscopic retrograde cholangiopancreatography balloon

Esophageal foreign bodies (EFB) are very important and critical entity that can lead to morbidity and mortality. EFB may cause serious complications such as perforation and mediastinitis. Thus, EFB should be treated quickly (1, 2). We report a case with EFB treated with a new technique; traction technique via endoscopic retrograde cholangiopancreatography (ERCP) balloon. A 60-year-old man admitted to the emergency department, with dysphagia that developed immediately after swallowing a fowl. He had no prior medical history. Physical examination was unremarkable. After endotracheal intubation, emergency endoscopy revealed impacted chick bone in the cervical esophagus just below the upper esophageal sphincter. We tried to remove the foreign body with a snare, then with a foreign body forceps, and we tried to mobilize it with mild pushing pressure but extraction of the foreign body was not achieved. We passed an ERCP balloon through upper esophagus, inflated the balloon, and then pulled it back (Fig. 1). The EFB was extracted successfully. After removal of foreign body, control endoscopy revealed mucosal erosion and ulcer on esophageal wall (Fig. 2).


Pleural effusion in acute pancreatitis, not always related

A 47 year-old male patient admitted to our hospital with chief complaints of severe epigastric pain, intermittent nausea and vomiting ongoing for 2 days. The patient's heart rate was 84/minute, body temperature was 37.4°C and skin and scleras were icteric at the initial presentation. Respiratory sounds could not be hearded at the basal levels of the right lung. Laboratory tests revealed as following; hemoglobin 10.6 g/dL (13.3- 17.2), C-reactive protein 96.4 mg/L (0-5), amylase 1300 u/l (28-100), lipase 318 u/l (13-60), aspartate aminotransferase 104 u/l (< 40), alanine aminotransferase 189 u/l (< 41), lactate dehydrogenase 450 u/l (240-480), gamma-glutamil transferase 283 u/l (8-61), alkaline phosphatase 376 u/l (40-130), direct bilirubin 4.36 mg/ dl (= 0.30). Chest X-ray examination revealed pleural effusion on the right side, coming up to the level of the fifth costa. (Fig. 1a). According to the abdominal computed tomography; intrahepatic bile ducts and the common bile duct (CBD) were dilated, gall bladder was hydropic as the thickest part of it was measured as 12 mm. Diffuse enlargement of the pancreas including contour irreegularities and inhomogeneous attenuation was seen.


Aseptic cerebral venous thrombosis associated with a gastric leiomyoma

In January 2015, a 38-year-old women consulted a neurologist for heavy diffuse headache, visual field defects, transient left paresthesia and seizures. She had no fever nor other complaint. She used DIV NUVARIN, an intravaginal ring, as contraceptive method. Her past medical history was only marked by an appendectomy during childhood. There was no objective neurological abnormality and the remainder of the examination was normal. CRP was slightly increased (21 mg/l) and the WBC count was 11680/mm3 with 92% neutrophils. Cerebral magnetic resonance revealed a superior sagittal sinus thrombosis without any abnormality inside the brain (Fig. 1). Standard tests of coagulation were normal. Tests for proteins S, C and antithrombin deficiency, antiphospholipid antibodies and homocysteinemia were negative. There was no factor V Leiden mutation, no biological nor clinical evidence for acquired prothrombotic condition. The patient was started on therapeutic anticoagulation with acenocoumarol and her clinical condition quickly improved.