Volume 86 - 2023 - Fasc.2 - Clinical images
Obscure digestive bleeding
A 50-year-old woman presented to the emergency
department with several episodes of melena in the last
week. The patient was not hemodynamically compromised
and was conservatively managed. Urgent upper gastrointestinal
endoscopy and colonoscopy showed no source
of bleeding. Abdominal CT demonstrated three mural
nodular lesions up to 2cm in the mid jejunum with
hypervascular characteristics in arterial phase without
active bleeding in venous phase. Angiography (Figure
1A) revealed three tumours with neo-angiogenesis
and no active bleeding. Each lesion was stained with
methylene blue and followed by embolization with coils.
Exploratory laparotomy (Figure 1B) showed the three
nodules marked by angiography. Intestinal resection of
the affected segment was performed. Histopathological
study proved the diagnosis of suspicion (Figure 2).
Unexpected outcome of a sigmoid lesion believed to be malignant
A 69-year-old male with a past medical history of
an Olfactory nerve meningioma and left-sided Bell’s
palsy presented with 6 weeks of lower abdominal
pain and weight loss of 4 kg in 6 months. His current
medications included acetylsalicylic acid 80 mg once
daily, Amlodipine 5 mg once daily and Allopurinol 300
mg once daily.
Physical examination was benign without signs of
acute abdomen. The abdomen was nondistended and
soft but tender to palpation over the left lower quadrant.
Laboratory studies showed no acute outliers.
The patient was followed up by his pulmonologist
because of thoracic lesions which required a PET-CT for
further evaluation. This PET-CT revealed a focal zone of
oedematous rectosigmoid colon with a strong suspicion
of a semi-circular sigmoid neoplasia with continuation
to the bladder (Figure 1a). A presumptive diagnosis of a
primary colonic malignancy was made.
Colonoscopy was performed and visualised a foreign
linear object lodged in both walls of the diverticular
sigmoid with surrounding inflammation, but otherwise
normal mucosa (Figure 1b). No arguments could be made
endoscopically to support the diagnosis of an underlying
primary colonic malignancy.