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Volume 80 - 2017 - Fasc.2 - Clinical images

Perforated pan-enteric tuberculosis: intra operative recognition necessity!

A 24-years-old man presented to the emergency department with complaints of progressively worsening abdominal pain, occurring on the background of fever. On examination, his abdomen was diffusely tender with board-like rigidity. His hematologic investigations revealed high blood cells count. After initial assessment a diagnosis of generalized peritonitis was made. He underwent emergency laparo- scopy, with intra operative findings of general peritonitis. The small bowl was dilated and the caecum was not in his usual localization. The conversion from laparoscopic to open surgery was decided. The small bowl wall was thick and tubular with no stricture (Fig. 1). There were two perforations situated on 1m50 and 1m80 from duodeno-jejunal junction. There were stony lymph nodes without sclerolipomatosis. The unusual location of the caecum was due to common mesentery (Fig. 1). We realized a peritoneal lavage and a resection of 40 cm of the small bowl. The two ends were brought out as double-barreled ostomy. An appendicectomy was also performed. A chest x-Ray (Fig. 2) was realized after surgery and showed pulmonary cavity and pulmonary interstitial syndrome.


Mediterranean lymphoma, an uncommon case of iron-deficiency anemia

A 57 year-old spanish man presented six-month period of iron-deficiency anemia. Physical examination was unremarkable. Upper endoscopy revealed mucosal edema and erythema beyond papilla of Vater with high mucosal friability. Specimen biopsies showed lymphoplasmacytic massive mucosal infiltration (Fig. 1) suggestive of immunoproliferative small bowel disease


A Coral Like Papillary Mass in the Gastric Cardia

A 75 year-old man was admitted with five kilograms of weight loss and dysphagia for three months to our clinic. Physical examination was unremarkable. Laboratory tests such as, complete blood count, liver enzymes, creatinine, and C-reactive protein were normal. Endoscopy revealed a coral like papillary mass in gastric cardia (Fig. 1). Histopathological examination of the mass biopsies taken during the endoscopy were compatible with hyperplastic, inflammatory changes. Endoscopy was repeated and deeper biopsies were taken from the mass. Microscopic examination revealed similar findings to those from the first endoscopy. Abdominal computed tomography of the patient showed a heterogenous lesion, 65 × 43 mm in size, located in the lesser curvature of the stomach but also extended to the gastroesophageal junction (Fig. 2). The patient underwent total gastrectomy. What is the patient's most likely diagnosis?


Quiz : Unusual whitish gastric mucosal lesion

A 71-year-old man underwent upper gastrointestinal endoscopy for screening of gastric cancer. No abnormal finding was found on the physical examination and the laboratory analysis. Endoscopy showed the irregular- shaped flat whitish mucosal lesion with slight central depression in lesser curvature of high body (Fig. 1a). This lesion was about 2.5cm in diameter and definitely away from normal esophageal mucosa of gastroesophageal junction. What is your diagnosis?