Volume 69 - 2006 - Fasc.3 - Letters
Cystic lymphangioma of the pancreas : a rare observation
Cystic lymphangioma of the pancreas is a rare benign and a slow growing lesion. The diagnosis remains a challenge for even the most experienced clinicians. We report a case of a pancreatic lymphangioma in a 31-year-old female complaining of epigastric pain, nausea, constipation and urticaria several weeks ago ; and we discuss diagnosis, anatomopathological findings and therapeu- tic attitude. (Acta gastroenterol. belg., 2006, 69, 330-331).
Autoimmune cholangitis in twin sisters
Autoimmune cholangitis is a controversial entity, which is considered either as antimitochondrial antibody (AMA) negative primary biliary cirrhosis (PBC), or a variant in a spectrum of autoimmune liver diseases (PBC, Autoimmune Hepatitis, Primary Sclerosing Cholangitis), or even an autonomous entity (1-3).
In our department, we have had the rare opportunity to confirm the concordance of autoimmune cholangitis in a pair of monozygotic twin sisters and to follow the very similar disease manifestation and subsequent course. They had been living in the same geographic region all their lives, having the same occupation (housewives) and very close social contact. The past medical history was unremarkable and negative for alco- hol or tobacco consumption. The age at diagnosis, inves- tigating fatigue and mild itching, was similar (57 years old in the first, 58 in the second) and the biochemical (raised alkaline phosphatase, ALT and low platelets) as well as the auto antibody profiles (positive ANA 1/160, weakly positive SMA 1/40, negative AMA, negative M2) were identical. The viral markers were negative in both patients and the iron studies, ceruloplasmin, a1- antithrypsin were within the normal range. Liver histol- ogy was alike in both sisters, characterised by predomi- nantly portal inflammation, bile duct damage and devel- opment of significant fibrosis, compatible with autoim- mune cholangitis stage III/IV. The disease course of the twin sisters was strikingly similar, characterised by decompensated liver disease approximately 3 years after the initial diagnosis, with multiple variceal haemor- rhages and endoscopic sclerotherapy courses at that time. Liver transplantation was not a possible option for them because of socioeconomical limitations.
Pneumothorax complicating endoscopic sphincterotomy successfully treated conservatively
Endoscopic retrograde cholangiopancreatography is an invasive procedure routinely performed for the diag- nosis and treatment of biliary and pancreatic diseases. Pneumothorax complicating endoscopic sphincterotomy is an exceedingly rare complication while the appropri- ate management of this clinical situation remains con- troversial. Duodenal perforation occurs in 1.1% of ERCP procedures and is associated with certain risk fac- tors namely precut sphincterotomy, length and direction of sphincterotomy, multiple attempts and a short intra- mural segment of the distal CBD (1-6).
Autoimmune cholangitis in twin sisters
Autoimmune cholangitis is a controversial entity, which is considered either as antimitochondrial antibody (AMA) negative primary biliary cirrhosis (PBC), or a variant in a spectrum of autoimmune liver diseases (PBC, Autoimmune Hepatitis, Primary Sclerosing Cholangitis), or even an autonomous entity (1-3).
Pneumothorax complicating endoscopic sphincterotomy successfully treated conservatively
Endoscopic retrograde cholangiopancreatography is an invasive procedure routinely performed for the diag- nosis and treatment of biliary and pancreatic diseases. Pneumothorax complicating endoscopic sphincterotomy is an exceedingly rare complication while the appropri- ate management of this clinical situation remains con- troversial. Duodenal perforation occurs in 1.1% of ERCP procedures and is associated with certain risk fac- tors namely precut sphincterotomy, length and direction of sphincterotomy, multiple attempts and a short intra- mural segment of the distal CBD (1-6).
