Volume 80 - 2017 - Fasc.1 - Letters
An unusual cause of dyspepsia due to a retained epicardial pacing wire
Temporary epicardial pacing wires (TEPWs) are frequently inserted in cardiac surgery procedures. Although overall morbidity related to TEPWs is low, complications related to the insertion, utilization, retrieval, and migration of these wires have been reported in the literature (1). In this report, we describe an unusual case of gastric migration of a TEPW, which eventually caused dyspeptic symptoms.
A 74-year-old man was admitted to our gastroenterology clinic for evaluation of worsening dyspeptic symptoms. Over the previous four months, he had suffered from continuous epigastric burning and pain. The patient had undergone coronary bypass grafting one year prior to the admission. On upper gastrointestinal endoscopy, a blue wire was identified that had penetrated the distal anterior wall of the gastric corpus (Figure 1). Retrieval of the foreign body was attempted but failed and the endoscopic procedure was terminated. For further evaluation, thoracic and abdominal computed tomography scans were performed. With imaging, the location and path of the wire were confirmed, from the right ventricle, passing through the sternocostal triangle, entering the abdomen, and penetrating the gastric wall (Figure 2). Consultation with cardiovascular surgery confirmed this wire to be a TEPW, which was cut at the surface of the skin after the bypass procedure.
Adenocarcinoma of the Rectum in a 27-year-old Patient with Usher Syndrome : Is there a Genetic Correlation?
Usher syndrome is an autosomal recessive disorder characterized by sensorineural hearing loss and impaired vision. Patients with Usher syndrome type 1C have a germline mutation in AIE-75/harmonin. This AIE- 75/harmonin binds to MCC2, homologue to MCC (mutated in colon cancer; MCC1) and is a possible tumor suppressor. Expression of AIE-75/harmonin suppresses growth of human colorectal adenocarcinoma SW480 cells.
We report a case of a young woman with Usher syndrome and a colorectal adeno-carcinoma.
A 27-year-old dark skinned woman with Usher syndrome presented at the emergency department with acute excessive fresh red rectal blood loss mixed with older brownish blood. She felt dizzy and sweaty, with tendency to lose consciousness.
In the recent past, she suffered from abdominal pain, hot flushes (sometimes fever), excessive sweating at night and diarrhea (sometimes with blood loss) often accompanied with joint pain. There is no history of weight loss. There are no urologic or gynecological abnormality's. Menstruation is regular due to oral contra- ception. She has no cardiothoracic complains. Because of Usher syndrome she is deaf and has an impaired sight. Two years ago the general practitioner diagnosed her with anemia.
Spontaneous isolated mesenteric fibromatosis associated with small bowel obstruction
A 65-year-old female presented with history of sudden severe abdominal pain associated with nausea and vomiting. On physical examination, the patient had abdominal distension with the mid-abdomen tenderness. A computed tomography (CT) scan of the abdomen revealed the presence of internal hernias (Fig. 1). An exploratory laparotomy was performed which showed adherences between nodules of the small intestine's mesentery and the upper jejunum near the ligament of Treitz and a dilated remote bowel. Microscopic examination showed fascicles of spindle cells surrounded by fibrillar collagen with few mitotic figures (Fig. 2). Immunohistochemistry revealed the tumor cells to be negative for CD 117 and desmin, but positive for ss-catenin stains consistent with the diagnosis of mesenteric fibromatosis.
Trichobezoar and Rapunzel syndrome : an unusual cause of abdominal mass
A 36-year-old lady was referred by her GP to the Gastroenterology clinic with a history of recurrent vomiting, abdominal pain and excessive belching. She reported these symptoms had recently worsened resulting in a decreased appetite. She denied any blood in her vomit or stool and any weight loss over this period. On examination a firm irregular mass in the epigastrium region was noted. The remainder of her examination was unremarkable.
All caecal ulcers is not Crohn's: Think Travel-Think again
A 29 year old male presented with sudden onset of right iliac fossa pain to the emergency department. He was experiencing recent change in bowel habits with lose stools and no rectal bleeding. His blood investigations revealed raised inflammatory markers with a C-reactive protein of 125 mg/l and white cell count of 14 X 109/L. Emergency diagnostic laparoscopy was performed for suspected acute appendicitis. This showed a normal appendix with erythematous and inflamed caecum with fibrin deposition and a small omental adhesion adjacent to it. An urgent colonoscopy showed a 2-3cm isolated ulcerated area in the caecum (Figure 1 and Figure 2) with normal Terminal ileum (Figure 3). Initial biopsies showed ulceration and chronic inflammation which raised a possibility of inflammatory bowel disease. He was reviewed in outpatient clinic and a further colonoscopic biopsy was arranged before embarking on steroid and immunosuppressive therapy, considering that he has travelled to India on two separate occasions prior to the onset of symptoms
Gastric Ulcers Related to The Transarterial Radioembolization of Yittrium-90 in A Patient with Paraganglioma
Paragangliomas (PGLs) are neuroendocrine tumors that arise from extra-adrenal neuroendocrine cells. Liver metastases of PGL which are not candidates for surgical resection can be treated by transarterial chemoembolization (TACE) when it is technically feasible (1). Selective internal radiation therapy (SIRT), in other words, radioembolization (RE) with biocompatible resin-based yttrium 90 (Y90)-labeled microspheres, administered via hepatic artery branches, is a method used to selectively deliver internal radiation therapy to liver metastases (2). However RE, has the potential to cause extrahepatic adverse effects if the microspheres are incorrectly delivered to arteries supplying the stomach, duodenum, or pancreas, as well as other organs. We present here a case of metastatic PGL with gastroduodenal ulcerations related to Y90 RE.
Azathioprine-induced acute pancreatitis in inflammatory bowel disease : natural history and severity spectrum
Crohn's disease (CD) and ulcerative colitis (UC) may present with various extra-intestinal manifestations, in- cluding acute pancreatitis (AP) (1). Recent studies es- timate that up to 7% of patients with CD treated with azathioprine develop acute pancreatitis, which is not dose-dependent and generally occurs 4 to 6 weeks after the beginning of the drug (2). However the pathogenic mechanism is unknown (3).
Our aim was to characterize the population of patients who developed azathioprine-induced AP in a tertiary referral center with a large number of treated IBD pa- tients. For that, we retrospectively identified all patients with IBD admitted to our Gastroenterology department for azathioprine-induced AP between January 2006 and December 2015.
Fistulization between stomach and transverse colon because of nasogastric feeding tube
Nasogastric tube is commonly used for nasogastric decompression, feeding, and gastric lavage. In the gastrointestinal tract, malposition, coiling, or knotting can occur anywhere along the course of the tube, including the pharynx, pyriform sinus, esophagus, stomach, and duodenum (1). Nasogastric tubes can cause gastritis or gastric bleeding because of chronic irritation or pressure necrosis (2). Patients with prior esophageal or gastric surgery have a higher risk for gastrointestinal perforation, and those with facial trauma are at a risk for cribriform plate perforation and intracranial insertion (3-4). However, there are no data regarding gastrocolic fistulization secondary to the use of a nasogastric feeding tube.