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Volume 86 - 2023 - Fasc.4 - Case reports

Watch-an-wait strategy for multiple rectal neuroendocrine tumors with widespread invasion

A 57-year-old man with a history of surgical resection for subocclusive small bowel Crohn’s disease, was referred for endoscopic follow-up. Rectal neuroendocrine tumor(rNETs) was found during screening colonoscopy in the form of a centimetric polyp. A post-polypectomy endoscopy was reassuring while random biopsies performed showed low grade multiple rNETs diffusely infiltrating the mucosa and submucosa. Both abdominal-pelvic computed tomography (CT) and endoscopic ultrasonography echoendoscopy (EUS) did not identify any lymph node or distant lesion. Watch-and-wait strategy was performed by regular colonoscopy and EUS. As far as we know, this case is the unique case reported of non-progressive diffuse multiple rectal neuroendocrine tumors after a very long-term follow-up of 20 years. This case further supports that “Watch and wait” could be a safe alternative management strategy for selected rNETs, specially in patients for whom the surgical risk is increased with a potentially significant impact on the quality of life.


Jejunal bleeding: a case report

Small intestinal bleeding remains a relatively uncommon event, accounting for 5-10% of all patients presenting with gastrointestinal bleeding. A rare but significant source includes hemangioma of the small intestine. Here we present a case of a 78-year-old female patient admitted with recurrent melena and iron deficiency anemia. After performing a normal upper and lower endoscopic examination, we suspected small bowel bleeding. Correspondingly, the patient underwent a video capsule endoscopy, showing a submucosal nodular lesion in the distal jejunum. Balloon enteroscopy clearly identified and inked the lesion, facilitating minimally invasive surgery. Pathology demonstrated a cavernous hemangioma. As we did not have a conclusive diagnosis preoperative and endoscopic intervention may have led to uncontrolled bleeding or perforation, laparoscopy was chosen to conduct a better evaluation. The present case findings emphasize that gastrointestinal hemangiomas, although uncommon, should be considered in the differential diagnosis of patients who present with unexplained gastrointestinal bleeding or other abdominal symptoms.


Banknotes in the stomach

In adults, foreign bodies are intentionally or accidentally ingested and may sometimes cause significant clinical consequences depending upon their physical and chemical features (1). Obstruction, perforation and penetration are the major gastrointestinal complications. Small and blunt objects mostly pass through the gastrointestinal system without any difficulties. Objects that fail to pass require endoscopic or surgical interventions (2). Endoscopic retrieval is the preferred therapeutic procedure if the type and location of the foreign body is relevant. Herein, we report a young refugee whom deliberately ingested a package of money before failed migration attempt and admitted to us for money retrieval from his stomach.


Successful treatment of ulcerative colitis with anakinra: a case report

Currently the effect of IL-1 blockade on ulcerative colitis (UC) is still ambiguous. This case report describes a patient with UC who developed severe complications after an episode of azathioprineinduced pancytopenia including cytomegalovirus pneumonitis, hemophagocytic lymphohistiocytosis, and probable pulmonary aspergillosis. Imaging after the hospitalization revealed a severe disseminated chronic candidiasis and persisting inflammation was seen. Genetic testing revealed heterozygous variants in NOD2 and NLRP12, and cytokine testing showed an increase in IL-1Ra, IL-18, CXCL9, and CXCL10. Consequently an IL-1 mediated autoinflammatory syndrome was suspected. Simultaneously, the patient developed a corticosteroid dependent UC flare-up. Treatment with anakinra was initiated for the IL-1 mediated disease which quickly induced remission of both the inflammatory syndrome and the UC.