Volume 61 - 1998 - Fasc.3 - Case reports
Acute intestinal obstruction caused by endometriosis mimicking sigmoid carcinoma
Endometriosis is a relatively frequent disease in fertile women. The intestine is involved in 12-37% of cases. Intestinal endometriosis is usually asymptomatic and complete obstruction of the bowel lumen occurs in less than 1% of cases. We report a case of endometriosis of the sigmoid, which caused complete,intestinal obstruction and mimicked carcinoma of the sigmoid colon. T@ case demonstrates the difficulty of establishing an accurate pre- and peroperative diagnosis and the propensity of intestinal endometriosis to mimic colon cancer.
Multifocal fatty infiltration of the liver an aspecific presentation form of hepatitis C infection
We present the case report of a 60 year old man with multiple focal echogenic lesions on ultrasound. While CT and MRI suggested the diagnosis of focal fatty infiltration of the liver, histology and serology showed a chronic hepatitis C infection. This is to our knowledge the first case of a patient with hepatitis C infection in whom focal steatosis could be seen on different imaging techniques.
Recurrent gastrointestinal blood loss of obscure origin: report of an exceptional case
A 66-year old tailor was admitted because of venous insufliciency of the left lower leg. During the hospital course, recurrent severe gastrointestinal blood loss developed. A classical approach was extended by enteroscopy and radionuclide scanning, followed by exploratory laparatomy with removal of two intra-abdominal sewing needles and a jejunal leiomyoma. After surgery, bleeding did not recur. This case illustrates the difficult diagnostic work-up of obscure gastrointestinal bleeding. It also shows that intra-abdominal sewing needles may migrate in the intestinal tract and remain silent during many years, eventually causing gastrointestinal bleeding.
Hypoxic hepatitis: a difficult diagnosis when the cardiomyopathy remains unrecognized and the course of liver enzymes follows an atypical pattern. A report of two cases
In a clinical setting of cardiac or circulatory failure, the diagnosis of hypoxic (ischaemic) hepatitis is easy and can be elicited on mere clinical and biochemical features. We report two cases of hypoxic hepatitis where cardiomyopathy remained unrecognized at admission due to the lack of conventional signs of congestive heart failure and where the increase in liver enzymes activities followed an atypical paftem, characterized by only moderate elevation of serum aminotransferases activities, low ASAT/ALAT ratio and elevated ALAT/ LDH ratio. This atypical paftem not suggestive of hypoxic hepatitis, could be explained by a delay between the onset of hypoxic injury of the liver and admission to hospital. Moreover one case was complicated by frank jaundice, an unusual feature in hypoxic hepatitis. Consequently, diagnosis and appropriate inotropic treatment were delayed resulting in progressive deterioration and eventually death of both patients. The report of these two cases and the review of other similar cases previously published, enlighten some atypical features of hypoxic hepatitis.
