Volume 87 - 2024 - Fasc.2 - Letters
A giant Brunner’s gland hamartoma: a rare cause of upper gastrointestinal bleeding
A 78-year-old man was admitted with melena, anemia
and hypotension. Upper endoscopy revealed a giant
lobulated and pedunculated lesion of the duodenal bulb
with an ulcerated area (Fig.1A-C). Biopsies performed
during upper endoscopy revealed foveolar epithelium
with no dysplasia. Abdominal CT showed a nodular
lesion protruding to the duodenal lumen with a diameter
of approximately 40mm (Fig.2A).
Giving the anemia, with recurrent transfusion
need, endoscopic resection was proposed. During the
intervention an endoloop was deployed at the base of the
pedicle and a hot snare polypectomy was successfully
performed without complications (Fig.1D). The patient
was discharged after the procedure, asymptomatic, with
no evidence of bleeding recurrence. Histology (Fig.2B)
was consistent with Brunner’s gland hamartoma (BGH).
Post-colonoscopy appendicitis: a thought-provoking unresolved entity
Meaningful coincidences exist in our daily medical
practice, awaiting recognition by those who possess keen
observation. While post-colonoscopy appendicitis is a
rare entity that is merely reported in the literature, there
are many pathophysiological explanations that could
make it more than just a coincidence.
At our center, we came across two documented
instances of post-colonoscopy appendicitis.
Recurrent cholangitis caused by a giant duodenal diverticulum (Lemmel syndrome) – effective treatment with endoscopic sphincterotomy
A 70-year-old male was admitted with abdominal pain and jaundice. Past medical history was relevant for severe chronic obstructive pulmonary disease and multiple cardiovascular risk factors. Biological tests revealed leukocytosis (18.5 x 109/L), hyperbilirubinemia (total bilirubin of 4.9 mg/dL and direct bilirubin of 2.8 mg/dL) and elevated C reactive protein (13.64 mg/dL) and liver enzymes (alanine aminotransferase of 562 UI/L, aspartate aminotransferase of 689 UI/L and alkaline phosphatase of 378 U/L). Abdominal CT showed a dilated biliary tree and no obstructive lesions. The patient started on antibiotics due to suspected acute cholangitis. A magnetic resonance cholangiopancreatography was performed, showing a giant duodenal diverticulum (shown in Fig. 1) involving the distal segment of the common bile duct almost circumferentially, leading to its collapse and upstream dilatation of intra and extrahepatic bile ducts, without luminal stones or stenosis. Imaging findings were consistent with Lemmel syndrome (LS).
Metabolic dysfunction-associated steatotic liver disease : the tree that hides the forest?
The world of hepatology has been recently shaken by a much-needed change of nomenclature validated by a large expert consensus (1). This consensus finally adopts positive diagnostic criteria for the recently renamed metabolic dysfunction-associated steatotic liver disease (MASLD) (Table 1) (1). This change in nomenclature is supported by scientific arguments published in the Acta Gastro-Enterologica Belgica (2). However, making the diagnosis of MASLD easy on the basis of the coexistence of hepatic steatosis (by imaging or histology) and just one cardiometabolic criterion (Table 1) (1) instead of a diagnosis of exclusion must not relegate other causes of chronic liver diseases to second place (3,4).
In Memoriam: René Fiasse (1936-2024)
It is with great sadness that we learned of the death of Professor René Fiasse on the 26th of February 2024, at the age of 87.
Born in Quiévrain in 1936 in the Borinage region, to two teachers, he was the eldest of four children. From an early age, he developed a quality that would mark him throughout his life: a committed humanism. Struck by the horrors of war, he became interested in international politics and then became actively involved in the pacifist movements and Amnesty International. Having received a pluralist education and thanks to his open-mindedness, he was always ahead of his time when it came to major ethical issues.
