Volume 86 - 2023 - Fasc.2 - Case reports
Endoscopic therapy for Bouveret syndrome, illustrated by a case report
Bouveret syndrome is an exceptionally rare form of gallstone
ileus secondary to a bilioenteric fistula, through which a
voluminous gallstone can migrate into the pylorus or duodenum,
thereby causing gastric outlet obstruction. In order to increase
awareness, we reviewed the clinical features, diagnostic tools
and management options for this uncommon entity. We
specifically focus on endoscopic therapeutic options, illustrated
by a case of a 73 year old woman with Bouveret syndrome, where
endoscopic electrohydraulic lithotripsy was successful in relieving
Child with protein losing enteropathy as presentation of collagenous duodenitis and eosinophilic gastroenteritis
Background: Collagenous duodenitis and gastritis are rare
histopathological findings in children.
Patients and methods: We describe a four-year old girl,
who presented with non-bloody diarrhea for two months and
progressive edema with an albumin of 16g/dl.
Results: The diagnosis of a protein losing enteropathy was
made. Extensive investigations withheld only an infectious cause of
the protein losing enteropathy (cytomegalovirus and adenovirus).
However, the patients still required repetitive albumin infusions
3.5 months after onset of symptoms without spontaneous recovery.
Therefore, a new endoscopic work-up was performed. Duodenal
biopsies revealed collagen deposition, in association with a high
number of eosinophils and mast cells throughout different parts of
the gastrointestinal tract.
Conclusions: The collagen deposition seems to be triggered by an
eosinophilic gastrointestinal disorder. Treatment was started with
amino acid-based formula, oral iron therapy, an antihistamine, and
a proton pomp inhibitor that resulted in persistent normalization
of serum albumin already after 1.5 weeks.
Respiratory involvement in Crohn’s disease: a case report
Inflammatory bowel disease (IBD) predominantly affects the
gastro-intestinal tract. There is however a large array of extra
intestinal manifestations (EIM) associated with these diseases. A
lesser known EIM is pulmonary involvement, which has been first
described in 1973. Since the introduction of HRCT more attention is
guided towards this specific involvement. Awareness of pulmonary
involvement in IBD-patients may lead to better screening, guide
appropriate therapy, and ultimately result in better patient care.
When untreated, serious and persisting complications, such as
stenosis or strictures of the large airways, as well as bronchiectasis
or bronchiolitis obliterans might occur.
Immune checkpoint inhibitor refractory colitis leading to total colectomy in a melanoma patient
Immunotherapy is becoming more and more relevant in the
treatment of advanced melanoma. Proper management of its side
effects can prevent severe complications. We describe the case
of a 73-year-old patient with severe refractory colitis secondary
to immunotherapy. The patient has been treated for 6 months
with Nivolumab, an anti-PD-1, as adjuvant therapy for locally
advanced melanoma. He was admitted to the hospital with a
deteriorating general condition associated with severe diarrhea
and rectal bleeding for 3 weeks. Despite three lines of treatment
(high dose corticosteroids, infliximab, mycophenolate mofetil),
the patient still presented clinical and endoscopic colitis, with
additional infectious complications. The patient required surgical
management for total colectomy. In this article we present one of
the rare cases of autoimmune colitis that did not respond to various
immunosuppressive treatments and required surgery.
Tofacitinib for celiac disease and microscopic colitis: killing two birds with one stone
Microscopic colitis is a chronic inflammatory condition of the colon. Firstline treatment consists of budesonide, with the consideration of biological agents in refractory cases. Celiac disease is a chronic immune mediated and gluten-induced enteropathy, with treatment consisting of a gluten-free diet. There is an association between microscopic colitis and instead of xand celiac disease, especially in refractory cases they can coincide. In this manuscript, we report for the first time the efficacy of tofacitinib, a pan Janus kinase inhibitor, in the treatment of concomitant microscopic colitis and celiac disease, resulting in persistent clinical and histological remission.
Are elevated systemic bile acids involved in the pathophysiology of sarcopenia and liver injury following gastric bypass?
Bariatric surgery is currently the most effective treatment
for sustained weight loss in severe obesity. However, recent data
describe the development of liver damage and in particular
massive steatosis and cholangitis in some patients, for which
certain pathophysiological mechanisms are suggested such as
bacterial overgrowth, malabsorption or sarcopenia. We describe
the case of a patient presenting with a new liver dysfunction 6 years
after a gastric bypass. The work-up revealed sarcopenic obesity
characterised by low muscle mass and low muscle function as well
as elevated fasting bile acids, severe liver steatosis and cholangitis.
The pathophysiology of this disease is complex and multifactorial
but could include bile acid toxicity. Bile acids are increased in cases
of liver steatosis, but also in cases of gastric bypass and malnutrition.
In our opinion, they may contribute to the loss of muscle mass and
the vicious circle observed in this situation. Treatment with enteral
feeding, intravenous albumin supplementation and diuretics
reversed the liver dysfunction and the patient was discharged from